Thesis (Ph.D.)--University of Adelaide, Dept. of Clinical Nursing, 2003. / "March 2003." Includes bibliographical references (leaves 340-350). Also available electronically.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2006. / Härtill uppsatser.

Thesis (M.S.)--University of Michigan, 1981.

Thesis (M.S.)--University of Michigan, 1981.

Bakgrund: Intensivvårdssjuksköterskor upplever intensivvårdsavdelningen som en stressfylld arbetsplats. Patienterna är svårt sjuka och akuta situationer kan hastigt uppstå. Miljön är högteknologisk och har stundvis ett högt tempo. Tidigare stressforskning har visat att en ökad stressnivå har en negativ inverkan på hälsan. Stresshantering utgår ifrån problemfokuserade – eller känslofokuserade copingstrategier. Syfte: Att beskriva de faktorer som stressar intensivvårdssjuksköterskor, samt hur de upplever och hanterar denna stress. Metod: En kvalitativ ansats med fokusgruppsintervjuer. Fem intensivvårdssjuksköterskor deltog. Intervjun var ostrukturerad med två öppna frågor. Materialet analyserades med hjälp av kvalitativ innehållsanalys. Resultat: Tre huvudkategorier och tio subkategorier framkom. Huvudkategorierna bestod av; Upplevda stressorer, Känslor och upplevelser av stress och Förmåga att hantera stress. Under intervjun framkom att stress framkallades under vissa arbetssituationer och i viss arbetsmiljö. Detta väckte känslor av frustration och maktlöshet hos intensivvårdssjuksköterskorna. Intensivvårdssjuksköterskorna använde en rad olika copingstrategier såsom till exempel att söka stöd samt planera och organisera sitt arbete, för att hantera stressfulla situationer. Slutsats: Det framkomna resultatet visade att intensivvårdssjuksköterskorna upplevde känslan av att varken räcka till eller kunna påverka sin arbetssituation. Detta ledde i sin tur till frustration och stress hos intensivvårdssjuksköterskorna. Trots detta fanns en hög nivå av trivsel. För att hantera den uppkomna stressen valde intensivvårdssjuksköterskorna att söka stöd hos varandra som den främsta copingstrategin Klinisk betydelse: Framkommen kunskap ur denna uppsats kan vara av betydelse för yrkesverksamma intensivvårdssjuksköterskor och deras arbetsmiljö. Även chefer kan ha användning av denna kunskap för att kunna organisera och ge intensivvårdssjuksköterskor stöd. / Background: Intensive care nurses perceive the Intensive Care Unit (ICU) as a stressful workplace. Patients are critically ill and emergency situations can occur quickly. The environment is high-tech and occasionally a high tempo. Previous stress research has shown that increased levels of stress have a negative impact on health. Stress management is based on problem-focused - or emotion-focused coping strategies. The Aim: To describe the factors that stress critical care nurses, and how they experience and cope with this stress. Method: A qualitative approach with focus group interviews. Five critical care nurses participated. The interview was unstructured with two open questions. The material was analyzed using qualitative content analysis. Results: Three main categories and ten subcategories emerged. The main categories consisted of: Perceived stressors, feelings and experiences of stress and ability to handle stress. During the interview revealed that stress was induced in certain work situations and in particular working environment. This caused feelings of frustration and powerlessness in ICU nurses. Critical care nurses used a variety of coping strategies such as seeking support and plan and organize their work, to cope with stressful situations. Conclusion: It originated results showed that intensive care nurses experienced the feeling of not enough or able to influence their work situation. This in turn led to frustration and stress among critical care nurses. Although this was a high level of comfort. To cope with the present stress chose critical care nurses to seek support from each other as the primary coping strategy Clinical significance: Arrived knowledge from this study may be important for professional’s intensive care nurses and their work environment. Although managers could use this knowledge to organize and provide critical care nurses support.

Bakgrund: Våld beskrivs som såväl fysiskt som verbalt våld men även som hot om våld. Det finns ingen entydig definition utan det är en individuell upplevelse. Vårdsektorn är en av de mest utsatta arbetsplatserna för våld och patienten är oftast den som utför våldshandlingen. Det finns flera orsaker till att patienter kan bli våldsamma. Det finns ett mörkertal i rapporteringen av våldshändelser. Att bli utsatt för våld medför flertalet negativa konsekvenser. Syfte: Syftet med studien var att beskriva intensivvårdsjuksköterskors upplevelser och erfarenheter av våld och hot om våld från patienter. Metod: Studien är av kvalitativ metod med deskriptiv ansats. Studien är utförd som en empirisk studie med en fokusgruppsintervju av fem verksamma intensivvårdssjuksköterskor. Resultat: Resultatet utmynnade i fem kategorier; olika former av våld, hotfull miljö, att utföra omvårdnad när en patient är våldsam, strategier och rapportering. Slutsats: Det gick inte att utföra omvårdnad på samma sätt när en patient var våldsam eller hotfull. Detta på grund av att intensivvårdssjuksköterskans egen säkerhet kom i första hand och att patienten inte alltid ville medverka till vård. Avvikelserapportering skrevs sällan eftersom våld från patienter ofta ansågs vara oavsiktligt. Klinisk betydelse: Resultatet av denna studie ger en ökad förståelse för intensivvårdssjuksköterskors arbetsmiljö när våld förekommer och hur det påverkar omvårdnaden av patienten. / Background: Violence is described as both physical and verbal abuse and also as threat of violence. The definition of violence varies and the perception of violence is individual. The health care sector is one of the most vulnerable to workplace violence and the patient is most often the perpetrator. There are several reasons why patients may become violent. The number of incidence is under reported. The consequences of exposure to violence are manifold. Aim: The aim of this study was to describe intensive care nurses' experiences and perceptions of violence and threats of violence from patients. Method: The study uses a qualitative methodology with a descriptive approach. The study is designed as an empirical study with a focus group interview of five intensive care nurses. Results: The analysis resulted in five categories: different forms of violence, a threatening environment, applying nursing care when a patient is violent, strategies and reporting. Conclusion: It was not possible to apply nursing care in the same way when the patient was being violent or threatening. That was because the nurse’s own safety came first and that the patient was unwilling to accept treatment. Written reports are uncommon because violence from patients was often considered to be unintentional. Clinical significance: The results of this study contribute to a greater understanding of the working environment of intensive care nurses.

Terminally ill patients and their families describe hospital care as nonsupportive to their needs during the final phase of life. Nurses generally are not comfortable with a supportive role when caring for the dying and tend to adhere to a curative role. The purpose of this descriptive, correlational study therefore was to describe the attitudes of general staff nurses working on medical-surgical units in hospitals towards the care of the dying and to ascertain the relationship between these attitudes and the education and experience of the nurses. An adaptation of the model for role episode, conflict, and ambiguity by Kahn, Wolfe, Quinn, Snoek and Rosenthal (1964) was the applied theoretical framework. The sample consisted of 197 randomly selected registered nurses employed full or part-time on general adult medical-surgical hospital units in British Columbia. The majority of the sample were married, Protestant females, between the ages of 26 and 45 years who were prepared at the diploma level in nursing. The mean length of time worked as a nurse was 8.5 years with a mean of 7.5 years on medical-surgical units. Attitudes towards the care of the dying were generally ambiguous, neither negative nor positive as measured by scores obtained on the ‘Questionnaire for Understanding the Dying Person and His Family’. Additionally, half the respondents did not believe that nurses should be the primary health care professionals equipped to deal with the emotional reactions of the dying yet three-quarters of the sample believed that patients turned to nurses to discuss such emotional issues. Data revealed that close to two-thirds of the respondents had received structured death and dying content in their basic nursing education yet less than half furthered their death and dying education since graduation. Overall death education for the sample was low. A small positive correlation (r=-0.26) was found between respondents' death education and their attitudes towards the care of the dying; no significant association was found between respondents' level of general nursing education and their attitudes. Although there was variability in the amount of professional and personal death experience, over half of the respondents experienced between one and three terminally ill patient deaths on their medical-surgical units per month. Additionally, the majority of respondents had experienced the death of an immediate family member. Overall death experience was low to moderate. A small, but significant positive correlation (r=0.24) was found between overall death experience and attitudes' towards the care of the dying; no significant association was found between general experience and attitude. Findings suggest that supportive nursing care is not being demonstrated with dying patients and their families. However, the influencing natures of death education and death experience on nurses' attitudes are positive, thereby providing the nursing profession with two possible ways of positively influencing nurses' attitudes to the care of the dying. / Applied Science, Faculty of / Nursing, School of / Graduate

PURPOSE: The purpose of this qualitative descriptive study was to describe critical care nurses’ experiences of moral challenges, moral distress, and moral resilience during the COVID-19 pandemic. The specific aims of this study were to: 1. Describe the moral challenges experienced by ICU nurses. 2. Describe moral resilience in terms of integrity, buoyancy, moral efficacy, self-regulation, and self-stewardship among ICU nurses (from Rushton’s framework). 3. Explore the relationship between moral distress and moral resilience to advance the concept of moral resilience in the face of the COVID-19 pandemic. FRAMEWORK: This study was undergirded by an adaptation of Rushton’s conceptual framework of moral concepts. DESIGN: A qualitative descriptive design was used. Participants were recruited between January to May 2021, and a semi-structured interview guide was utilized to interview participants. RESULTS: 17 participants were interviewed for the study. Participants described the four themes of moral challenges: death and dying, pain and suffering, being alone, and being helpless and not in control. Moral resilience was described as: integrity, buoyancy, moral efficacy, self-regulation, self-stewardship, and self-perception. The relationship between moral distress and moral resilience was described as iterative and fluid. CONCLUSION: The findings of the study provided a new domain of moral resilience called self-perception and a revised adaptation of the conceptual framework for moral resilience.

Bakgrund: I slutet av 2019 spreds sjukdomen Covid-19 och i mars 2020 deklarerades det som en pandemi. Sjukdomen resulterade i en stor mängd intensivvårdskrävande patienter vilket krävde stora resurser från hälso- och sjukvården. Historiskt har omfattande epidemier under 1900-talet påverkat vården på liknande sätt och sjuksköterskor som har arbetat under dessa har upplevt en stor arbetsbelastning vilket påverkat deras mående. Syfte: Att beskriva intensivvårdssjuksköterskors upplevelser och erfarenheter av att arbeta med intensivvårdskrävande patienter drabbade av Covid-19 under år 2020. Metod: Intensivvårdssjuksköterskor från tre intensivvårdsavdelningar i Mellansverige intervjuades i fokusgrupper angående deras upplevelser av att vårda patienter med Covid-19. Intervjuerna transkriberades och analyserades enligt Krueger och Caseys (2015) konstant jämförande metod. Resultat: Resultatet sammanställdes till 5 kategorier och 15 koder. Kategorierna var Personliga uppfattningar, Pandemins påverkan på vården, Relationen med patient och närstående, Arbetsgivarens hantering och Yrkets framtid. Konklusion: Intensivvårdssjuksköterskorna upplevde en ansträngd arbetssituation, där stress och utmaningar av att arbeta i skyddsutrustning var utmärkande. Arbetsbelastningen upplevdes leda till en hotad patientsäkerhet. Sjuksköterskorna upplevde en bristfällig beredskap inom organisationen. De saknade konkret klinisk information samt stöd från arbetsgivaren. För- och nackdelar av att inte ha närstående närvarande på avdelningen diskuterades och slutligen uttryckte sjuksköterskorna en oro inför framtiden. / Background: At the end of 2019, Covid-19 disease took spread and in March 2020 it was declared as a pandemic. The disease claimed large resources from the health care system. Epidemics during the 20th century have affected the health care system in a similar way and nurses working during these conditions have experienced a great workload, which affected their well-being. Aim: To describe the Critical Care Nurses [CCN] experiences working with patients suffering from Covid-19 during the year of 2020. Method: CCN from three critical care units in Sweden were interviewed in focusgroups regarding their experiences of caring for patients with Covid-19. The interviews were transcribed and analyzed according to Krueger and Casey's (2015) constant comparative method. Results: The results were compiled into 5 categories and 15 codes. The categories were Personal perceptions, The pandemic's impact on care, The relationship with the patient and their relatives, The management by the employer and The future for the profession. Conclusion: CCNs experienced a strained working situation, where stress and challenges of working in protective gear were characteristic. This led to a perceived endangered patient safety. The nurses experienced a lack of preparedness within the organization, they lacked information and support from their employer. Impacts of not having the patient's relatives present were discussed and finally the nurses expressed concern about the future.

Bakgrund: Övervikt och fetma hos barn är en av 2000-talets största hälsoutmaningar. Världshälsoorganisationens målsättning är att år 2025 minska förekomsten av barnfetma globalt. Barnhälsovårdssjuksköterskor innehar en nyckelroll i att upptäcka och vägleda familjer med barn som har övervikt och fetma. Därmed är det betydelsefullt att få kunskap om barnhälsovårdssjuksköterskans upplevelse av dessa möten och vilka faktorer som påverkar. Syfte: Syftet med studien var att belysa barnhälsovårdssjuksköterskans upplevelse av att bemöta familjer med barn som har övervikt och fetma. Metod: Studien genomfördes med en kvalitativ design med induktiv ansats. Semistrukturerade intervjuer utfördes med sju barnhälsovårdssjuksköterskor inom barnhälsovården i en region i sydöstra Sverige. Datamaterialet analyserades med en kvalitativ innehållsanalys. Resultat: Analysen resulterade i två kategorier och åtta subkategorier. De två kategorierna var: Ett utmanande möte: Majoriteten av deltagarna upplevde att det utgjorde ett känsligt och svårt samtalsämne. Vidare beskrevs hindrande faktorer såsom kulturella skillnader gällande levnadsvanor samt att barnet var närvarande vid besöket. Samtal om övervikt och fetma bidrog i sin tur till motstridiga känslor av bekräftelse samt misslyckande hos deltagarna. Dock uttryckte deltagarna att det var deras skyldighet att ta upp ämnet med familjen för att ha möjlighet att få till en förändring. Aspekter som påverkar mötet: Deltagarna upplevde flera underlättande faktorer bland annat att familjen själva tog upp problematiken. Att formulera sig korrekt och tänka igenom det som skulle förmedlas var av vikt. Det var betydelsefullt att ge familjen tid att hantera informationen vilket ofta bidrog till ett gott resultat. Slutsats: Barnhälsovårdssjuksköterskans upplevelse av att bemöta familjer och samtala om barnets övervikt och fetma upplevs ofta som svårt och känsligt. De ansåg att det var ett av de mest utmanande samtalsämnena inom deras profession. De var rädda för att skuldbelägga eller kränka familjen. De upplevde att tid och resurser behövdes för att skapa ett förtroende med familjen vilket sågs som en underlättade faktor. När familjen känner ett förtroende ökar följsamheten och känslor som glädje och bekräftelse infinner sig hos barnhälsovårdssjuksköterskan. / Background: Childhood overweight and obesity is one of the 21st century greatest health challenges. World Health Organization's goal is to reduce the prevalence of child obesity globally by 2025. Child health nurses holds a key role to detect and guide families with children who are overweight and obese. Therefore, it is important to gain knowledge of the child health care nurse experience of these meetings and what factors that affects. Aim: The purpose of the study was to illuminate child health care nurses experience of meeting families with children who are overweight and obese. Method: The study was conducted with a qualitative design with an inductive approach. Semi-structured interviews were conducted with seven child health nurses in three child health care centers in a region in the southeast of Sweden. The data material was analyzed with a qualitative content analysis. Results: The analysis resulted in two categories and eight subcategories. The two categories were; A challenging meeting: Most of the participants felt that it made a sensitive and difficult topic of conversation. It resulted in several different parental reactions that the participants had to respond to. Hindering aspects were described as when the child were present at the visit and cultural differences in terms of lifestyle. Discussing overweight and obesity contributed to conflicted emotions of confirmation and failure among the participants. They expressed that it was their responsibility to address the topic with the family to have the opportunity to bring about a change. Aspects that affected the meeting: The participants experienced several facilitating aspects of the conversation like when the family themselves highlighted the problem. It was important to express oneself correctly and think through what was to be communicated. It was crucial to give the family time to let them handle the information which often contributed to a good outcome. Conclusion: The child health care nurses experience of meeting families and talk about childhood overweight and obesity is often perceived as difficult and sensitive. They considered that it was one of the most challenging topics of conversation within their profession. They were afraid of blaming or offending the family. They experienced that time and resources were needed to create trust with the family, which was seen as a facilitated factor. When the family trust and compliance increase the child health care nurse experience joy and a feeling of affirmation.