Bakgrund: En specialistsjuksköterska inom akutsjukvård med inriktning mot ambulans- och/eller intensivvård hanterar hjärtstopp enligt algoritmen för avancerad hjärtlung-räddning och verkar i komplexa situationer såväl prehospitalt som intrahospitalt, där krav ställs på specialistsjuksköterskan att kunna tolka tillstånd, hantera avancerad utrustning och läkemedel samt ställs inför etiska och komplexa situationer.  Syfte: Att belysa specialistsjuksköterskors erfarenheter av att delta vid hjärtstopp  Metod: Kvalitativ metod med deskriptiv ansats. Intervjuerna genomfördes med en semistrukturerad frågeguide, vilket gav möjlighet för följdfrågor. Tio deltagare intervjuades och intervjuerna analyserades med hjälp av kvalitatitv innehållsanalys av Graneheim & Lundman (2004).  Resultat: Studiens resultat presenteras i två kategorier. Den fokuserade experten samt Människan med behov för återhämtning och reflektion. Arbetet som specialistsjuksköterska inom akutsjukvård med inriktning mot ambulans- och/eller intensivvård ger deltagarna upplevelser som påverkar dem i både yrket och privat. Förberedelser att hantera situationerna sker i form av utbildning i avancerad hjärtlung-räddning men också erfarenheter av att delta vid hjärtstopp är viktiga för att utvecklas i yrkesrollen och hantera utrustningen som finns tillhanda för hjärtstopp. För att kunna hantera upplevelserna krävs, förutom stödinsatser av arbetsgivaren i form av debriefing, även informellt stöd av kollegor samt personliga copingstrategier. Konklusion: Arbetet som specialistsjuksköterska kräver avancerade kunskaper och förberedelser i form av utbildning, hantering av medicinteknisk utrustning men även upplevda erfarenheter, för att kunna formas i sin yrkesroll. Att genomföra formella debriefingar, använda kollegialt stöd och egna copingstrategier gör att specialistsjuksköterskor hanterar exponeringen av att möta patienter med hjärtstillestånd till en hanterbar situation. Dock anser en del av specialistsjuksköterskorna att det finns brister som kan förbättras vad gäller utbildning för att hantera hjärtstopp. / Background: A specialist nurse in emergency care with focus on prehospital- and/or intensive care manages algoritms for cardiac arrests and are active in complex situations, both pre- and intrahospital, were the specialist nurses have demands on them to interpret conditions, manage advanced equipment and drugs and are encountered to ethical and complex situations.  Purpose: To enlighten the experiences of specialist nurses when managing cardiac arrests, the complexity that sorrounds the situation whenever a patient is in cardiac arrest, could give the specialist nurse tools to better understand and cope with that type of emergency situations and increase safety in their professional role Method: Qualitative method with a descriptive approach. The interviews were conducted through a semi-structured interview guide. Ten participants were interviewed and the interviews were transcribed and analyzed according to qualitative content analysis by Graneheim & Lundman (2004). Result: The result of the study is presented in two categories, the focused expert and the person with need for recovery and reflection, with seven sub categories belonging to the categories. Working as a specialist nurse within emergency care with focus on prehospital- and/or intensive care and taking care of patients in cardiac arrest give the participants in this study experiences that affect them both professionally and private. Preparation to manage cardiac arrests involve training in advanced cardiopulmonary resusciation but also experiences of participating during cardiac arrests are important to evolve in their professional role and manage the equipment that are being used for cardiac arrests. To be able to manage the experiences they need to accept supportive measures from their employer and informal measures such as peer-support and personal coping strategies.  Conclusion: The role of being a specialist nurse in emergency with focus on prehospital  and/or intensive care demands advanced knowledge and preparations through education, managing medical technology equipment and lived experiences, in order to be shaped in their professional role. By conducting formal debriefings, use peer-support and their own coping strategies the specialist nurse manage to cope with exposure of meeting patients in cardiac arrest. However, some of the specialist nurses considers there should be room for improvement regarding their education to manage cardiac arrests.

Bakgrund: I takt med att befolkningen åldras ökar risken för fallolyckor. Specialistsjuksköterskans arbete med fallprevention i hemsjukvården ställer krav på adekvat kompetens för att minska risken för onödigt lidande för den äldre samt för att minska samhällskostnader relaterat till fallolyckor. Syftet med studien är att belysa specialistsjuksköterskans arbete med fallprevention för äldre kvarboende i hemmet. Metod: Kvalitativ induktiv ansats. Nio intervjuer med specialistsjuksköterskor har genomförts och data analyserades med kvalitativ innehållsanalys. Resultat: Specialistsjuksköterskans arbete med den äldre är att identifiera riskfaktorer i hemmet som kan påverka fallrisken. Samtalet med den äldre är en viktig del i det fallförebyggande arbetet. Utmaningar identifieras i samtalet med den äldre med kognitiv svikt och specialistsjuksköterskan upplever otydligheter i sin roll i det fallpreventiva teamarbetet .Slutsats: Specialistsjuksköterskan behöver en ökad kunskap kring sin roll i det fallpreventiva teamarbetet och mer utbildning i utformningen av samtalet med den äldre med kognitiv svikt som är kvarboende i hemmet. / Background: With an increasing population of older people, fall accidents occur in higher numbers. The specialist nurse's work with fall prevention in elderly care requires adequate competence to reduce the risk of unnecessary suffering for the elderly as well as to reduce societal costs related to fall accidents. Aim: The aim of the study is to shed light on the specialist nurse's work with fall prevention for elderly people still living at home. Method: Qualitative study with inductive approach. Interviews with nine specialist nurses were conducted and data was analysed with qualitative content analysis. Results: The specialist nurses' work with the elderly includes identifying risk factors in the home that can affect the risk of falling. Communication with the elderly and informing about risks in everyday life is a large part of the work. The specialist nurses experience a lack of competence in talking to elderly people with cognitive impairment regarding fall prevention and the specialist nurses experience their role as unclear in the fall preventive teamwork. Conclusion: An increased knowledge as to what role specialist nurses have in teamwork and fall prevention is crucial. Education related to conversation with older people with cognitive impairment are identified by the specialist nurses as something to improve.

Bakgrund: Amning ger en rad fördelar för både barnets och moderns hälsa på kort och lång sikt. Världshälsoorganisationen (WHO) rekommenderar helamning under barnets första sex månader. Trots det ses en minskning av andel barn som helammas i åldersgruppen noll-sex månader. Här har specialistsjuksköterskor på barnavårdscentralen en viktig uppgift att tidigt identifiera problem och ge mödrar stöd att amma. Motiv: Amningsfrekvensen sjunker i Sverige, allt färre barn under sex månader helammas. Få studier har utförts som beskriver specialistsjuksköterskors attityder om amning inom barnavårdscentralen (BVC). Genom en sådan kartläggning av attityder kan kunskap erhållas som kan vara av vikt i utvecklandet av metoder som syftar till att stödja föräldrar i amning, vilket skulle kunna bidra till en ökad amningsfrekvens. Syfte: Syftet med studien var att kartlägga specialistsjuksköterskors attityder till amning på barnavårdscentralen i fem regioner i Sverige.  Metod: Studien genomfördes som en tvärsnittsstudie med en kvantitativ deskriptiv design med bekvämlighetsurval. För att mäta attityder hos specialistsjuksköterskor användes en modifierad The Lowa Feeding Attitude Scale (IIFAS). Totalt deltog 42 personer i studien och de samband som studerades var om utbildningsnivå, ålder, extra amningsutbildning eller yrkesverksamma år hade någon betydelse för specialistsjuksköterskors attityd om amning.  Resultat: Respondenterna fick ett medelvärde på 72,5 poäng när de svarade på instrumentet. Det indikerar att respondenterna i studien har neutrala attityder om amning. Inget signifikant samband hittades mellan respondenternas attityder och deras ålder, yrkesverksamma år inom BVC, vilken specialistutbildning respondenterna hade eller om de hade genomfört en extra amningskurs. Konklusion: Studiens resultat visade att specialistsjuksköterskor generellt hade ett neutralt förhållningssätt till amning. Detta indikerar att det finns förbättringsområden. Amningsutbildning är av vikt inom BVC för att förbättra attityder om amning hos specialistsjuksköterskorna inom Barnhälsovården (BHV). Framtida forskning inriktat mot specialistsjuksköterskans attityder om amning behövs för att kartlägga behovet av utbildning och extra insatser för att påverka amningsfrekvens hos befolkningen. / Background: Breastfeeding provides several benefits for both the child's and the mother's health. The WHO recommends exclusive breastfeeding during the child's first six months. Despite this, a decrease is taking place in the proportion of children who are fully breastfed in this age. The specialist nurses at the child health center have an important task of identifying problems early and giving mothers support to breastfeed. Motive: The breastfeeding rate is falling in Sweden. Few studies have been conducted that describe specialist nurses' attitudes about breastfeeding. Through such a mapping of attitudes, knowledge can be obtained that can be of importance in the development of methods aimed at supporting parents in breastfeeding. This could contribute to an increased frequency of breastfeeding. Aim: The aim of this study was to map specialist nurses' attitudes about breastfeeding at the child health care center in Sweden.  Methods: The study was conducted as a cross-sectional study using a quantitative descriptive design with convenience sampling. To measure attitudes of specialist nurses, a modified IIFAS was used, it also included age, level of education, additional breastfeeding training and professional work years. A total of 42 people participated in the study. Result: Respondents scored an average of 72.5 points when answering the instrument, which indicates neutral attitudes about breastfeeding. No significant correlation was found between the respondents' attitudes and their age, professional work years in child health care, level of education or if they had completed an additional breastfeeding training. Conclusion: The results of the study showed that specialist nurses generally had a neutral approach to breastfeeding. Breastfeeding training is important to enhance attitudes about breastfeeding among the specialist nurses. Future research aimed at specialist nurses' attitudes about breastfeeding is needed to map the need for training and extra efforts to influence breastfeeding frequency in the population.

Försvarsmaktens resa har fram tills nyligen präglats av att myndigheten krymper. Vi har sett hur invasionsförsvaret övergick till ett insatsförsvar som i större uträckning fokuserade på verksamhet utomlands Insatsförbanden utrustades med modern materiel som i de flesta fall var i bruk hela tiden. Materielen fanns hos förbanden. Med få insatsförband förfogade Försvarsmakten över en tillräcklig mängd fordon för att kunna förse alla insatsförband med den utrustning de skulle ha. Stegvis förändrades säkerhetsläget i Sveriges omgivning. Under 2014 skedde en stor förändring när Sveriges ÖB undertecknade ett värdlandsavtal med NATO. Avtalet innebär bland annat att NATO kan bistå Sveriges Försvarsmakt med materiel såsom fordon i händelse av kris eller krig. Olika styrdokument har efter hand växt i omfattning och präglas i hög grad av att Försvarsmakten använder sina egna fordon. Detta ligger till grund för den tekniska utbildning som Försvarsmakten nyttjar. Den tekniska officeren förlitar sig på att det finns anvisningar, utbildning och kurser, regler och tillvägagångssätt för många av de situationer som uppkommer inom den tekniska tjänsten, men vad händer om teknikern plötsligt befinner sig utanför de ordinarie ramarna och måste agera utan anvisningar och anpassade regler? Försvarsmakten är nu inne i ett annat skede för första gången på länge, den växer. Tillväxten innebär att Försvarsmakten inte har fordon i tillräcklig mängd för att fylla insatsförbanden. Lösningen på fordonsbristen är att man krigsplacerar civila fordon som man anser vara ändamålsenliga. I framtiden kan det alltså se annorlunda ut där den tekniska specialistofficeren plötsligt stöter på fordon som har tillförts från det civila samhället eller kanske genom värdlandsstöd. Kan Försvarsmakten behöva se över sin utbildning och sitt tillvägagångssätt, för att bättre fostra det tekniska skrået för att möta morgondagens materiel? I denna studie använder vi oss av en induktiv, kvalitativ studie med intervjuer och workshop som vi sedan analyserar med Grounded Theory. Vår teoretiska referensram är lärandet genom olika perspektiv. Resultatet av vår studie har vi belyst genom att konstruera en modell för att bättre utveckla och skapa riktade förutsättningar för att i slutändan producera tekniska officerare som har bättre förutsättningar att lyckas vid en mobilisering än vad dagens tekniker har. / Until recently, the journey of the Armed Forces has been characterized by the shrinking of the organization. We have seen how the old invasion defence transitioned to a smaller more mobile response defence that focused to a greater extent on activities abroad. The Quick Respond Units were equipped with modern equipment, which in most cases was in use all the time. The equipment was with the units. With few units, the Swedish Armed Forces had a sufficient number of vehicles to be able to supply all units with the equipment they would need. Gradually, the security situation in Sweden's surroundings changed. In 2014, a major change took place when Sweden's ÖB signed a host country agreement with NATO. The agreement means, among other things, that NATO can aid the Swedish Armed Forces with material such as vehicles in case of a crisis or war. Various governing documents have gradually grown in scope and are characterized to a considerable extent by the Armed Forces using their own vehicles. This is the basis for the technical training that the Armed Forces use. The Technical Officer relies on the existence of instructions, training and courses, rules and procedures for many of the situations that arise in the technical service, but what happens if the technician suddenly finds himself outside the normal framework and must act without instructions, regulations and adapted rules? The Armed Forces are now in a different stage for the first time in a long time, the Armed Forces are growing. The growth means that the Armed Forces do not have vehicles in sufficient quantity to fill the need for expanding number of units. The solution to the vehicle shortage is to deploy civilian vehicles that are considered fit for purpose. In the future, then, things may look different where the technical specialist officer suddenly comes across vehicles that have been supplied from civil society or perhaps through host country support. Could the Armed Forces need to review their training and approach, to better nurture the technical guild to meet the equipment of the future? In this study, we use an inductive, qualitative study with interviews and workshops, which we then analyse with Grounded Theory. Our theoretical frame of reference is learning through different perspectives. We have summarized the results of our study by constructing a model to better develop and create targeted conditions to ultimately produce technical officers who have better conditions to succeed in a mobilization than today's technicians have.

Background: Autism and other neurodevelopmental disorders (NDD) are common in low- and middle-income countries (LMIC). However, services to address the needs of this group in LMIC are almost non-existent. The World Health Organization (WHO) developed the Caregiver Skills Training (CST) programme to be suitable for delivery in diverse global contexts. Ethiopia, the country of focus in this study, has a largely rural population and a lack of specialist service providers. Additional contextual challenges, including poverty, low literacy, limited access to healthcare and a lack of specialist child mental health services, may undermine the delivery of CST in this setting. This thesis, therefore, seeks to explore the acceptability and feasibility of non-specialist delivery of the WHO-CST from the perspective of providers and caregivers in rural Ethiopia. Methods: In Chapter one, a general literature review of neurodevelopmental disability and caregiver skills training is presented, with a focus on sub-Saharan Africa, to help contextualise the main qualitative study, outlined in chapter two. In-depth interviews were conducted with caregivers (n=19) who were all participants in two rural pilot studies of the WHO-CST programme. In addition, three focus group interviews were conducted with non-specialist facilitators (n=8), who facilitated the CST programme in two rural pilot tests. Data were analysed using the framework approach. Results: Findings were mapped onto the three framework themes created for this analysis: 1) Programme content: caregivers and facilitators uniformly indicated that the adapted programme addressed a need and was relevant for their context; caregivers emphasised how the programme helped them understand their child's problems and improve their skills to support their children; facilitators highlighted having acquired new knowledge and skills relating to NDD; 2) Programme facilitation: caregiver responses suggested that programme facilitation by non-specialists was acceptable; non-specialist facilitators emphasised the importance of support and supervision for the facilitators and simplification and modification of some concepts, such as the concept of play, and 3) CST training approach and delivery: participants indicated that the training modalities, including home visits and group training, were acceptable and feasible in the local context. Conclusions: This study suggested that, with some contextually appropriate modifications of programme content and delivery and continuing supervision of facilitators, the WHO-CST programme facilitated by non-specialists would be acceptable and feasible in rural Ethiopia. Results from this study may be useful to fine-tune the implementation of non-specialist delivery of the CST programme in Ethiopia, as well as other LMIC.

The purposes of this study were to explore the needs and concerns of the siblings of children hospitalized with a chronic illness and to explore the role that Child Life Specialists play in the lives of siblings. Face-to-face and telephone interviews with Child Life Specialists from three central Florida pediatric hospitals were conducted and analyzed. Through these interviews, I gained the perspective of the Child Life Specialist’s role concerning the needs and concerns of siblings as well as their role in meeting those needs. The interviews were tape-recorded and later transcribed and analyzed with a qualitative approach. I predicted that the results would show many similarities among Child Life Specialists' perceptions related to their experiences with siblings and would solidify the role that they play in meeting the needs of siblings. This study validated the worth of the Child Life Specialist in the hospital setting in aiding in the psychosocial development of hospitalized children and their families. I concluded from the data that all of the Child Life Specialists agreed that they were needed in the hospitals to help siblings deal with the psychosocial needs separate from the needs of the hospitalized child. All the Child Life Specialists helped siblings in the hospital; however there was a fair amount of inconsistency regarding how the needs of siblings were met. All the Specialists believed they were relieving anxiety; with differences in the methods to relieve anxiety. They all believed they made a positive impact in the siblings’ hospital experiences with a fair amount of variance in their perceived level of impact. There are very few research studies in the fields of child development and child life regarding psychosocial development of siblings of chronically ill children. Therefore, I felt it pertinent to conduct an exploratory study that would provide relevant and factual information to both fields that could, in turn, inspire future research in both fields. Through this study, I have discovered that Child Life Specialists employ a variety of methods in meeting the needs of siblings of children diagnosed with a chronic illness. I have also discovered that Child Life Specialists perceive themselves as being able to make a positive impact on the coping and psychosocial needs of the siblings of children hospitalized with chronic illness Further research in this area is needed. First and foremost, a study is needed in which the siblings are interviewed so that their needs are correctly identified, and Child Life Specialists can intervene appropriately. Second, this particular study focused on central Florida, and future studies should expand the geographic regions to other areas of the United States. Third, this particular study focused on chronic disease diagnosis of the child in the hospital, and additional studies are needed so that all siblings of all children in the hospital for any reason are studied. Therefore, I predicted that siblings would have different needs of attention from one another, depending on diagnosis of chronically ill sibling and family situation, and that Child Life Specialists would employ a variety of methods in differentiating for and meeting those needs.

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