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<p>Förstagenerationsinvandrares syn på delaktighet vid vård i livet slutskede tycks det aldrig tidigare forskats kring. Det väckte författarnas intresse. Om förstagenerationsinvandrarnas syn skiljer sig från författarnas syn på delaktighet, kan vi då utan kunskap bemöta dem respektfullt? Syftet med studien var att beskriva förstagenerationsinvandrares erfarenheter av delaktighet när den närstående gavs vård i livets slutskede. En kvalitativ intervjustudie och textanalys genomfördes. Resultatet visade att de närståendes livssituation påverkades i positiv eller i negativ riktning. Majoriteten av de närstående upplevde att de fick otillräcklig information. Det skapade osäkerhet vid vårdandet av den sjuke. Resultatet visade också att de närstående kände ett stort behov av att finnas i närheten av den sjuke under sjukdomsperioden. Dålig ekonomi i intervjupersonernas forna hemländer medförde att en del närstående tvingades vårda den sjuke i bostaden. Delaktigheten i vården upplevdes då som en skyldighet eller självklarhet. Andra intervjupersoner kände att det var deras ansvar att ordna sjukhusvård åt den sjuke. Att som närstående vårda den sjuke upplevdes påfrestande och därför bör det finnas en valmöjlighet att vid behov kunna överlämna huvudansvaret för vården till professionell sjukvård. Studien bidrar till förståelsen om att människor har olika syn på delaktighet vid vård i livets slutskede.</p>

<p>Endast en procent av alla bröstcancerdrabbade per år är män. Det är ett område som är eftersatt i forskningen och dåligt uppmärksammat av både vården och samhället. Syftet med studien var att undersöka mäns upplevelser av att drabbas av bröstcancer. Den metod som användes var i form av en litteraturstudie med kvalitativ ansats. Urvalet bestod av sju vetenskapliga artiklar som fokuserade på mäns upplevelser av att leva med bröstcancer som sedan granskades utifrån Polit och Becks (2010) kriterier. Datainsamlingen gick till på så sätt att lämpliga databaser söktes igenom med sökorden: attitude, breast cancer, breast neoplasms, experience, living with, male, male breast cancer, men. Den teoretiska referensramen som valdes för denna studie var begreppet skam. Resultatet visade på informationsbrist, känslor av skam av att plötsligt drabbats av en typisk kvinnosjukdom, svårigheter att acceptera sjukdomen och dess följder samt att en ny syn på livet uppkom efter sjukdomstiden. Författarnas slutsats är att det finns ett behov av mer könsspecifik information för att öka kunskapen hos både män och vårdpersonal. Medvetenheten om att män kan drabbas av bröstcancer bör öka såväl i vården som i samhället för att minska mäns upplevelse av skam.</p>

<p>Att leva med en kronisk sjukdom som astma påverkar den sjukes liv på många sätt. Både samhälleliga och personliga vinster finns med att patienten har kontroll över sin sjukdom. Därför är det viktigt att vården stöttar och ger kunskap som underlättar för patienten att leva med astma. Det krävs att patienten får en information som är individanpassad för att han/hon ska kunna omsätta kunskaperna i praktisk handling. Metoden som användes i studien var kvantitativ med en enkät som datainsamlingsmetod. Syftet med undersökning var att beskriva vilken erfarenhet som patienter med astma har av den information de får angående sin sjukdom. Resultatet i studien visade att de flesta astmatiker tyckte sig ha fått den information de behövde för att må så bra som möjligt. Vi kan se att kunskapen gett dem trygghet att handskas med sin astma samt att denna kunskap kan omsättas i praktisk handling.</p>

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SAMMANFATTNING Bakgrund: En stor andel av den vuxna befolkningen lider av långvarig smärta. Möjligheten att bli helt fri från denna smärta är tyvärr liten. Som följd av detta skaffar sig de drabbade personerna olika strategier för att göra smärtan hanterbar och överkomlig i vardagslivet. Syfte: Syftet med studien var att utifrån bloggar beskriva copingstrategier hos personer med långvarig smärta. Metod: En studie med kvalitativ ansats genomfördes med bloggar som datamaterial. Urvalet var nio bloggar skrivna av kvinnor i åldrarna 32-49 år som alla hade smärtdiagnoser. En tematisk strukturanalys användes som analysmetod. Resultat: Resultatet gav upphov till två huvudteman, Coping med stöd av sina inre resurser, respektive Coping med stöd av sina yttre resurser. Dessa huvudteman beskriver vanliga copingstrategier som fungerade och användes frekvent av de studerade personerna. Slutsats: Det är essentiellt att personer som drabbas av långvarig smärta skaffar sig fungerande copingstrategier för att kunna hantera den stress som långvarig smärta innebär. Det är viktigt att vården uppmärksammar och framhåller vikten av dessa strategier för de som lider av långvarig smärta, då detta främjar välbefinnandet och lindrar lidandet.

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This research focused on the life situation of older people, who had moved to a nursing home at the end of life, from the perspectives of the older people themselves, care managers and nursing staff. The thesis is based on an analysis of 446 care manager assessments and decisions, interviews with seven care managers, six older people and 28 nursing staff. The main fi ndings are: (I); that there was a statistically signifi cantly shorter waiting time for a move to a nursing home for older people who were in hospital compared to those who were living in their own home at the time of the decision. Seventy percent of the decisions made by care managers’ concerned women. The waiting period for men was fi ve days shorter compared to women. (II); that the care managers’ descriptions revealed that their assessments of the needs and wishes of the older people were infl uenced by whether or not it was clear that the older person had only a limited time left to live. The care managers’ way of reasoning has been conceptualised as two approaches, the medical and the natural path to death, where the former was characterised as fl exible and collaborative, whereas the latter was governed to a greater extent by a “wait and see attitude”. (III); that the older people’s experiences of living in a nursing home have been conceptualised into three themes: feeling like a stranger in an unfamiliar culture, being excluded from life, and living while waiting for death. The latter involved a deep insight that life would soon come to an end; a fact the staff appeared to take into account to only a minor extent. (IV); that dying and death was characterised by a discourse of silence, with tension between avoidance of and a confrontation with death. Staff members who expressed a fear of death held it at a distance by concentrating on practical tasks and avoiding close contact with older people who were dying. The thesis highlights the fact that the dying and death of older persons was characterised by a discourse of silence and several transitions. Death was not a topic that the staff members or older people generally talked about, and care in the fi nal phase of life was not actively or explicitly planned. In terms of access to a nursing home bed, only older people with an extensive need for care obtained such a place. These fi ndings imply that all older people can be said to be in need of palliative care. The older people in our study were in a liminal phase, and waiting for death. Feelings of social and existential loneliness and that their living space was shrinking were evident. It was also clear that the older people and staff members inhabit the same place but appear to be in two different sub-cultures, where the norms and values that guided the staff members’ attitudes were dominant. Keywords: transition, older people, end of life care, palliative care, nursing home, caring, care manager and staff

Aim: The overall aim of this thesis was to gain a deeper understanding of F-LNMs’ leadership. Another aim was to examine possible differences in self-rated health between F-LNMs and registered nurses (RNs) on various psychosocial factors. Method: Study I and III are single case studies. Study I concerns a first-line nurse manager working in a unit for care of older people. Data collection comprised of two interviews, observations, and documents. A hermeneutic approach was used for the analysis. Study II was carried out in three units at three Swedish hospitals. Three F-LNMs and 14 RNs participated. Interviews were used to collect data. The interviews were analysed using qualitative content analysis. Study III was conducted at a palliative care unit. Data were collected using three separate instruments: a questionnaire, group interviews with nurses and leaders, and documents. Qualitative content analysis was used to analyse the material. Study IV was conducted at a university hospital. Seventy-eight F-LNMs and their 1,806 subordinated RNs participated in the study. Data were collected using a web-based questionnaire (Web-QPS) to assess the participant’s psychosocial work environment and their self-rated health. Result: The main finding in study I was that the F-LNM goal-profile consisted of three goals - the nurse goal, the administrator goal and the leadership goal. The administrator and leadership goal were in accordance to her job description, while the nurse goal was interpreted as a personally chosen and prioritised goal. In study II the result was illustrated in one main theme referred to as between being and doing. The RNs and F-LNMs described what it was to be a good professional (being), how they were engaged in creating a good work climate (doing) and personal outcomes of this project (gaining). In study III the result showed that the most important component at the palliative care unit was to accomplish the vision of good palliative care. Congruence in leadership, mature group functioning, adequate organisational structures and resources, and comprehensive and shared meaningfulness were all identified as essential components for fulfilling the vision. In study IV both F-LNMs and RNs found their work in general important, interesting and meaningful and reported self-rated health as good. However, about 10-15% shoved signs of being at risk for stress related ill health. The results showed statistically significant differences in the distribution between the F-LNMs and the RNs on three indices: job control, job demand and managerial support in a direction which would be favorable to the F-LNMs. Conclusion: Nurses and F-LNMs seem to have high ideals and expectations of giving good care. The value- system of nursing, i.e. providing the best care for each patient, seems to be a point of departure for the F-LNMs leadership. Key factors for obtaining this are sufficient resources and adequate structures as well as good climate in the teams. One can therefore assume that the F-LNMs should be based on creating a healthy and sustainable work environment that promotes the quality of care and employee well-being. This is obtained by promoting development of ethical competence of the F-LNMs themselves as well as the employees. F-LNMs’ work conditions have a significant impact on how they can support and promote such a development. 

Health-related quality of life (HRQL) has become an important outcome in asthma, since traditional outcomes, such as respiratory symptoms and pulmonary function, might not entirely express the patient’s perception of the limitations caused by the disease. The aim of this thesis was to study HRQL in asthma and to analyse if HRQL was related to asthma onset and prognosis. Other aims were to identify determinants of low HRQL in clinically-verified asthmatics, and to study whether low HRQL was a predictor of mortality. In 1990, a self-administered questionnaire was completed by 12,560 individuals from three age groups (16, 30-39, and 60-69 years) in two counties of Sweden. In a second phase, all subjects who reported a history of obstructive respiratory symptoms (n = 1,851) and 600 randomly-selected controls were invited to a clinical investigation including spirometry, allergy testing, and assessment of HRQL with the Gothenburg Quality of Life instrument. In 2003, the eligible subjects in the cohort (n=11,282) were sent a new questionnaire. Mortality data in the cohort was followed up during 1990–2008 using data from the National Board of Health and Welfare Mortality Database. The 616 subjects with clinically-verified asthma 1990 had significantly lower HRQL than subjects without asthma. In the 2003 follow-up, the 305 subjects with persistent asthma had a lower HRQL than the 155 subjects who showed improvement in asthma during the follow-up. Subjects who had developed asthma by the follow-up had a significantly lower HRQL at baseline than those who did not develop asthma. Significant determinants of quality of life in asthma were female sex, smoking habits, higher airway responsiveness to irritants, respiratory symptom severity, positive skin prick test, and absenteeism from work or school. Low HRQL was related to increased mortality, but this association was not found when analyzing the asthmatic group alone. In conclusion, measurements of HRQL are of value for evaluating both the impact and progression of asthma.