Svenska ambulanssjukvården hanterar dagligen trauma händelser som skapar lidande för såväl patienter som närstående. En allvarlig händelse är en händelse då resurserna inte täcker det behov som finns utan kvalitetskraven måste sänkas. Genom att arbeta vetenskapligt och standardiserat under allvarliga händelser så kan mortaliteten bli lägre och lidandet minska hos patienterna. Författarna tror att den svenska ambulanssjukvården inte har tillräcklig beredskap för att hantera de allvarliga händelserna som sker i landet. Syftet med studien var att undersöka om ambulanssjukvården i Sverige har beredskap för att ge snabb vård i samband med allvarliga händelser med flertalet drabbade. Problemet undersöktes med en kvantitativ ansats med data som innehöll tider från allvarliga händelser i Sverige under åren 2010-2014. Totalt 414 händelser där sju ambulanser eller fler var inblandade analyserades och där skillnader hittades inom responstiden, platstiden, tiden till sjukhus samt när alla patienter var avtransporterade. Studien visar att vid de flesta tillfällena när ambulanssjukvården håller uppsatta tidsmål så har det positiv effekt på övriga insatstider vilket i slutändan leder till ett minskat patientlidande. Dock visar även resultatet att tidsmålen inte efterlevs i den utsträckningen som de bör göra vilket leder till att patienterna inte får den vård de har rätt till. Med detta som utgångspunkt drar författarna slutsatsen att den svenska ambulanssjukvården inte har beredskap för de allvarliga händelserna.

Yoga as a therapeutic modality for treating trauma is currently emerging as an important topic of research with several new studies being produced to analyze its effectiveness on varying populations of traumatized individuals. Research is beginning to demonstrate that individuals who suffer the effects of trauma have often experienced several negative events that accumulate over the course of one’s lifetime. It has been displayed that when treated early, the adverse effects of trauma may be much less debilitating. Recent studies indicate traumatic memories are often stored within the body and are difficult to recall through cognition alone. Therefore, somatic therapies such as yoga are proving to be an effective means of working through this unresolved trauma. Using a constructivist and postmodernist lens with a narrative methodology, this study explores the impact of yoga on children and youth who have experienced trauma as witnessed by yoga instructors teaching to these populations. Seven participants who reside in British Columbia, volunteered to share their stories and experiences through individual semi-structured interviews. The narratives highlight a potential pathway to healing trauma through several shared factors. These common threads indicate that yoga can provide children and youth a safe space to explore their bodies, develop a sense of community and belonging among peers, as well as engage in a mindfulness practice that incorporates several healing factors such as asana (the physical postures of yoga) and pranayama (connecting to one’s breath). Opening to vulnerability was another common thread indicated as a necessary component to healing that occurred for many children and youth throughout the practice of yoga. This study contributes to the growing research of yoga as a therapeutic modality for healing trauma in children and youth. / Graduate

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Objectives: This thesis aimed to investigate whether a history of childhood trauma was indirectly associated with eating psychopathology through mediation by dissociation and/or emotion dysregulation. Method: Firstly, a systematic review was conducted to appraise the current level of evidence within the literature that supported dissociation as a potential mediator. To this end, studies that assessed the variables of childhood trauma, dissociation and eating psychopathology within a single study were identified and systematically reviewed. Secondly, an empirical cross-sectional study was undertaken to investigate a multiple mediation model of the association between childhood trauma and eating psychopathology which included dissociation and emotion dysregulation as potential mediators. 165 undergraduate Psychology students took part in this study. Participants completed measures of childhood trauma, eating psychopathology, dissociation and emotion dysregulation. Experiences of multiple forms of childhood trauma were assessed, including emotional abuse (CEA), physical abuse (CPA), sexual abuse (CSA), emotional neglect (CEN) and physical neglect (CPN). Results: The results of the systematic review were inconclusive regarding the potential role of dissociation as a mediator in the relationships between childhood trauma and eating psychopathology. Findings within the reviewed studies generally offered more support for associations between childhood trauma and dissociation and dissociation and eating psychopathology. Studies reported more inconsistent findings regarding the association between childhood trauma and eating psychopathology. The results from the empirical study indicated that CEA and CEN were both significantly associated with increased eating psychopathology within the whole sample. These relationships were significantly mediated by both dissociation and emotion dysregulation. A separate analysis with female participants only, indicated that CPA and CPN in addition to CEA and CEN were significantly associated with increased eating psychopathology. The associations between CEA, CEN, CPN and eating psychopathology were all significantly mediated by both dissociation and emotion dysregulation. Dissociation and emotion dysregulation did not mediate the association between CPA and eating psychopathology. Conclusions: The studies included within the systematic review offered tentative support for an indirect relationship between childhood trauma and eating psychopathology through dissociation. Firm conclusions were limited, however, due to a number of methodological shortcomings identified within the included studies. The main methodological shortcomings concerned the definition and measurement of childhood trauma and the failure of a number of studies to address theoretical models within their research design. Addressing both of these methodological limitations, the results of the empirical study provided support for the growing consensus that emotional maltreatment may be an important risk factor for the development of eating psychopathology. Further, the results of this study indicate that childhood trauma impacts indirectly on eating psychopathology through an enduring effect on both dissociative and emotion regulation processes.

Bakgrund: Akutmottagningen är en sjukvårdsinstans dit patienter med plötsligt insjuknande eller skada kommer för hjälp. På akutmottagningen arbetar sjuksköterskor vars arbete grundar sig i att ge god omvårdnad utifrån patientbehov samt utför vissa medicinsktekniska åtgärder. Sjuksköterskor ska visa empati och agera ur ett etiskt ändamålsenligt sätt i mötet med patienter. Till trauma räknas när människokroppen utsatts för högenergetiskt våld genom trafikolycka eller penetrerat/icke-penetrerat våld. Schusters avhandling visar hur sjuksköterskors upplevelser av arbetet påverkar privatlivet, hennes profession och hur dessa existentiella rum påverkar varandra. Syfte: Syftet var att beskriva sjuksköterskors upplevelser av att arbeta på akutmottagning med patienter som inkom med fysiskt trauma. Metod: En allmän litteraturstudie baserad på sex kvalitativt inriktade vetenskapliga artiklar. Resultat: Innefattar tre kategorier: (1) upplevelser av svåra och komplexa situationer, (2) upplevelser av vikten av att skapa relationer (3) upplevelser av att arbeta under stress. Resultatet visade hur sjuksköterskor hanterade den emotionella påverkan i mötet med traumapatienter, relationers betydelse på arbetsplatsen och hur osäkerhet yttrade sig i arbetet på akutmottagning. Slutsats: Coping-strategier, kollegialt stöd och stress var de redskap och känslor som sjuksköterskor beskrev var del av hennes arbete med traumapatienter. / Background: The accident and emergency (A&E) department, a health care setting where patients with acute illness or injury arrive for assistance. In the A&E the nursing tasks is based around providing good care in regard to the patients’ needs and perform certain medical technical measures. Nurses should show empathy and act in an ethically appropriate manner when treating patients. Trauma is defined as when the human body is exposed to high-energetic violence suffered from an accident or from penetrating/non-penetrating violence. Schuster's thesis shows how nurses' work experiences affects their private life and their profession. Aim: The aim was to describe nurses' experiences of working in the A&E with patients who arrives with physical trauma. Method: A literature review based on six qualitative scientific articles. Results: Three categories: (1) experiences of difficult and complex situations, (2) the importance of creating relationships and (3) experiences of working under stress. Results showed how nurses dealt with emotions when encountering trauma patients, the importance of relationships in the workplace and how uncertainty reflected in the work at the A&E. Conclusion: Coping strategies, peer support and stress were the functions and emotions nurses described as part of her work with trauma patients.

On January 12, 2010, a 7.0 wide magnitude earthquake hit Haiti and thousands of Haitians were left to cope with the aftermath, and many mental health concerns began to surface (Amnesty International, 2011; Cénat & Derivois, 2014). The main purpose of this study is to understand post-earthquake psychosocial issues in the Haitian context by studying the experiences of Natives in Haiti. This study provides implications for counseling support from international emergency response workers, counselors, counselor educators interested in providing mental health training in Haiti or other developing countries, and researcher's interested in increasing knowledge that has real impact on mental health issues in Haiti. This study aims to answer: "What are the experiences of Haitian Natives post-2010 earthquake in Haiti and the implications for providing appropriate post-crisis psychosocial support?" <br>This qualitative inquiry used Bronfenbrenner's bio-ecological model of human development (Bronfenbrenner, 2005) as a theoretical framework. Seven Haitian Natives who survived the earthquake in La Ville, Haiti shared their beliefs, personal narratives, and the culturally responsive care they received after the earthquake. Some of the participants also took part in a focus group. Informants' responses were translated and transcribed, and Interpretative Phenomenology Analysis (IPA) was used to analyze the transcription and field notes. Conceptual models captured the process and outcomes of psychosocial issues related to post-earthquake context in this study and were compared with previously developed conceptual frameworks. The findings of the study yielded nine themes and 27 sub themes. The findings suggest that the interviewee's experiences were both negative and positive. Some of the negative experiences were continuous trauma symptoms such as panic, worry, and fear. Some of the positive experiences were unity, leadership development, posttraumatic growth, and new appreciation for professional mental health. Based on the conclusions and results from this study, implications will be stated as they relate to practice, teaching, and scholarship. / School of Education; / Counselor Education and Supervision (ExCES) / PhD; / Dissertation;

Fenomenet sekundär traumatisering är främst utforskat i USA, och är ett relativt okänt begrepp i Sverige. Denna studie undersöker om sekundär traumatisering förekommer bland svenska professionella som möter traumatiserade individer i sitt arbete. Det empiriska underlaget består av fyra kvalitativa intervjuer. Intervjupersonerna valdes ut genom snöbolls/kedjeurval respektive subjektivt urval. Kvalitativ innehållsanalys användes som analysmetod av det empiriska materialet. Resultatet visar att det förekommer symtom som kan förklaras som sekundär traumatisering men är svårt att fastställa eftersom begreppet är komplext och saknar  tydliga gränser mellan redan vedertagna liknande fenomen som utbrändhet och motöverföring. Oavsett hur fenomenet rubriceras visar resultatet att det finns ett problem där professionella inte har nog med kunskap om vilka risker detta fält kan medföra och hur det påverkar det professionella- och inte minst det privata välbefinnandet. De främsta organisatoriska skyddsfaktorerna ansågs vara handledning, kollegialt stöd och tid för reflektion. Socialt stöd från nära relationer nämnes som en privat skyddsfaktor. Copingstrategier som nämnes var fysisk aktivitet, positivt förhållningssätt och bibehålla ett socialt liv. Personlig terapi framfördes som ett förslag till egenvård.

MPH (Hospital Management), Faculty of Health Sciences, University of the Witwatersrand

Depuis lannée 2010, un flux de nouvelles migrations vers le Brésil explique larrivée de populations de primo-arrivants (notamment des Congolais, Angolais, Syriens, Haïtiens). Ces nouvelles populations interrogent la clinique psychanalytique auprès des migrants. En effet, leur expérience de violence extrême et leur condition précaire les caractérisent et exigent un renouvellement des questionnements et des modalités dintervention cliniques. A travers des réflexions sur la clinique avec des sujets migrants dans les institutions d\'accueil de la ville de São Paulo, nous espérons contribuer à la réflexion sur de nouvelles possibilités d\'intervention clinique. En partant de la notion de trauma comme une modalité de souffrance du sujet face à un événement vécu comme désastre, nous réfléchissons aux possibilités de conception de nouveaux éléments d\'intervention clinique, ainsi quaux formes de positionnements analytiques dans la rencontre avec le migrant. Nous proposons, à un stade de notre réflexion, une comparaison avec la prise en charge des migrants à Paris, France, où larrivée récente de migrants a également exigé la mise en place de nouveaux dispositifs cliniques. Ainsi, à partir de cas cliniques menés dans les deux villes, cette recherche propose de qualifier le traumatisme, puis limpact opéré dans la prise en charge par les langues et les cultures, enfin les injonctions institutionnelles et les questions raciales et coloniales présentes tout au long de la trajectoire des migrants. En prenant comme objet la rencontre clinique entre les migrants nouvellement arrivés et le psychanalyste, nous essayerons de réfléchir aux possibilités dintervention clinique dans des conditions extrêmes, capables de produire de nouvelles significations pour le sujet. Nous montrerons en quoi les différents positionnements de l\'analyste sont au centre de nouveaux dispositifs cliniques, puisque ce dernier peut être pris entre, dune part, l\'excès d\'implication dans la souffrance du patient, et dautre part, dans la distanciation nécessaire, qui produit alors des effets de désaveu pour le sujet. De cette manière, nous souhaitons contribuer à la pratique psychanalytique en contexte extrême, en particulier avec la population migrante et /ou exilée / A partir de um fluxo acentuado de migrações para o Brasil, iniciado particularmente desde os anos 2010, novas populações, recém-chegadas (particularmente congoleses, angolanos, sírios e haitianos), passaram a interpelar a clínica psicanalítica com migrantes. Provenientes de realidades de violência extrema e condições precárias, as vivências dos sujeitos migrantes são marcadas por especificidades que vêm demandando novos questionamentos. Através de reflexões sobre a clínica com migrantes em instituições de acolhimento na cidade de São Paulo e na cidade de Paris, pretendemos sedimentar aportes teóricos para elaborar novas possibilidades de intervenção clínica, trabalhando a posição do analista e as vicissitudes desse encontro. Compreendendo o traumático como o sofrimento do sujeito diante de um acontecimento vivido como desastre, pensaremos nas possibilidades de fabricação de elementos clínicos de intervenção, assim como nas formas de sustentação de posições analíticas no encontro com esse sujeito migrante. Assim, debruçada sobre as experiências clínicas nas duas cidades supracitadas, tanto institucionalmente como em outras situações, a pesquisa pretende refletir sobre a dimensão do traumático, das diferenças de línguas e culturas, sobre as injunções institucionais e as questões raciais e coloniais presentes nas trajetórias de migrantes. Tomando como objeto, portanto, o encontro clínico entre migrante recém-chegado e o psicanalista, trataremos de refletir sobre as possibilidades tanto de intervenções clínicas em condições extremas, capazes de produzir ressignificações para o sujeito, como nas distintas posições possíveis para o analista, que frequentemente se encontra entre o excesso de implicação no sofrimento, de um lado e de outro, um distanciamento que produz efeitos de desmentido para o sujeito. Desse modo, pretendemos contribuir com elementos clínicos e teóricos para a prática de psicanálise em contextos extremos, particularmente com a população migrante e/ou em situação de refúgio