The aim of the study was to examine the background and prerequisites for social services responsibility for carers according to the carers’ section in the Social Services Act. How the legislation is perceived and implemented in practice was also studied. The study’s theoretical basis was jurisprudence and the sociology of law. Preparatory work and other sections of importance for the interpretation of the carers’ section in the Social Services Act were also scrutinized. Interviews with four municipal politicians and four local civil servants were conducted. Various factors which affect the prerequisites for the social services duty of care towards carers were identified in the study. By studying the direct effects of legislation various indirect effects were also highlighted. The results showed that legislation is a weak instrument of control in municipalities’ planning and implementation of support for carers. Therefore social services responsibility for carers is unclear and imprecise. For carers themselves it is difficult to know what support they can demand or ask for from social services – municipalities have to offer support for carers but the carers’ section does not give carers any legal right to support.

This research examined the impact on parents and carers of having a child placed at a residential special school for abused, neglected and traumatised primary aged children. The school is developing its work with families and carers, because if relationships at home are improved, children are more likely to benefit from the placement at Stowbury. Although it is the child who is referred, establishing a good working relationship with parents and carers is vital in helping them with their child’s return home. The study focused on parental experiences of the child’s first year at the school, using interviews at the start of placement and then twelve months later. The data were analysed using a comparative thematic analysis at two time points and a secondary narrative analysis. Researcher reflexivity is used and where appropriate the findings are discussed from a psychoanalytic perspective. The analysis found that during the first year the children make positive changes. Birth parents were helped with their parenting, particularly the (re)establishment of parental boundaries. In contrast, some foster carers found it difficult to share the parenting role, and tensions between home and school were identified. Some parents and carers found it difficult to reflect on their role and relationship with their child. In general, parents and carers expected their child to be able to go to mainstream school when they left Stowbury, and after one year some realised that was unlikely. The study concludes that the experience of foster carers could be improved if they were helped to increase their ability to reflect on their parenting role. In addition, sharing the parenting of this group of children can cause tension between parents, carers and staff. There are training implications for the professionals involved. This research makes an original contribution to knowledge about the psychodynamics that develop in the relationships between the parents, carers and staff looking after abused children in a residential school.

L'évolution de la psychiatrie contemporaine est marquée par le basculement d'une partie importante de la prise en charge vers les familles. De ce fait, les situations de cohabitation du patient avec ses frères et sœurs sont de plus en plus fréquentes.Faisant suite à une recherche-action portant sur 600 frères et sœurs de personnes atteintes de troubles psychotiques, cette recherche s'inscrit dans une approche compréhensive qui donne une place centrale à l'expérience et à l'analyse qualitative de cas.La recherche permet de mieux comprendre la nature spécifique des retentissements de la schizophrénie sur la fratrie qui combine crainte de la contamination, contagiosité psychique et emprise. Il convient de prendre en compte ces trois dimensions pour développer une information et un accompagnement approprié pour les frères et sœurs. La recherche permet de repérer l'actualisation de la tension spéculaire lors de l'apparition des troubles, non seulement pour les frères et sœurs du patient, mais aussi pour le patient lui-même. Si elle est trop intense, la tension spéculaire peut faire peser une menace sur l'ensemble des frères et sœurs, avec de surcroit pour le malade la crainte de représenter lui-même une menace pour le reste du groupe. Ceci peut conduire à des mouvements radicaux de séparation et de collage pour les frères et sœurs du patient, mais aussi de repli pour la personne malade. En revanche, si elle est supportée par la fratrie, la tension spéculaire peut soutenir la capacité réflexive du patient et ainsi représenter un levier thérapeutique.Les situations de cohabitation, quand elles sont banalisées et contraintes, renforcent la tension spéculaire. Il convient donc de prendre en considération l'ensemble des personnes qui sont amenées à vivre sous le même toit que la personne malade lors de sa sortie d'hospitalisation. La recherche montre que soutenir les relations fraternelles dans les situations de cohabitation représente un intérêt non seulement sur le plan préventif pour les frères et sœurs, mais aussi sur le plan curatif pour la personne malade. / Recent developments in contemporary psychiatry are underlined by an important change involving families as caregivers. As a consequence, more and more brothers and sisters live with their diseased sibling. This research project follows a previous research and action project involving 600 siblings of psychotic patients. This work follows a comprehensive approach that gives central focus to experience and qualitative analysis of cases.Research allows us to better understand the specific nature of schizophrenic impact on siblings that are fearful of contamination, psychic infectiousness and its influence. We need to take into account those 3 dimensions in order to develop information as well as proper follow-up for brothers and sisters.Research also allows us to identify conjoined mirror imaging between the patient and his siblings. When not too strong, this mirror imaging can represent a danger on the siblings as well on the patient himself who can see himself as a potential threat for the rest of the group.This dynamic can lead to radical movements of separation or bonding between brothers and sisters but also as a fall-back for the patient. On the other hand, if this mirror imaging is well supported by siblings, it can generate insight by the patient on his own condition and become a strong therapeutic adjunct.When co-habitation situations are trivialised, mirror imaging can become stronger. It is therefore important to consider everybody that lives under the same roof as the patient as he is discharged.Research shows that proper support of siblings relationships in cohabitation situations can lead to benefits not only on the preventive side for the siblings, but on the therapeutic side for the patient.

The aim of this study was to analyse the role of the registered nurse in the management of pro re nata (PRN) medication in a care home (nursing) for older people. Studying PRN medication provides insights into the role of the nurse in care homes (nursing) who act as assessor, decision maker and evaluator in residents' care. It also provides a lens by which to explore how residents and their carers interact and participate in day-to-day care decisions about residents' health. The case study draws on ethnography. It is a multi-method study, using documentary and medication reviews, observations and interviews to answer the research questions. Thirty-four residents were recruited to the study and 60 care home staff. Findings showed that 88.2% of residents (n=30) were prescribed PRN medication and that all residents were on a minimum of 1 and a maximum of 7 medication. During each 28-day MAR sheet period between 35 and 44 PRN prescriptions were written. They contributed 12.7% of all medication prescribed, accounting for between 1.2 and 1.5 medication per resident. Nurses were found to administer PRN medication, but a finding of this study was that this activity could be delegated to carers who were identifying resident needs. There was some evidence of resident engagement but this was often a three-way process between resident, GP and family or resident, carer and nurse. A percentage of medication that could have been PRN were routinely prescribed. Observations also identified that nurses would decide not to administer routine medication in certain circumstances and that this was directly related to their assessment of the resident. The process of medication management was dominated by the regulations and governance processes of the care home. Observations and interviews found that care home staff recognised and affirmed residents' pain but did not take action for analgesia to be administered. They were familiar with the use of pain assessment tools for older people living with dementia and had received training in dementia care. Many of the staff were also able to interpret signs and symptoms of a resident's distress. Nevertheless, their preoccupation with meeting internal and external regulator standards was a barrier to addressing residents' needs. This is the first study that has looked at an aspect of medication management to understand how nurses and care home staff work for and with residents to moderate and address their health care needs. It suggests that additional training in aspects of medication management and resident assessment may not be able to address deeper seated issues of autonomy and how the nursing role is understood and enacted in care home settings.

The diploma thesis deals with foster care in the Czech Republic as well as it represents its legislation. The thesis follows up psychosocial aspects that are closely connected with foster care. It describes aspects such as psychosocial parenthood and motivation, which encourages foster parents to provide foster care. Also, it represents system of values and motives, that are very significant when considering foster care. The thesis investigates the needs of foster parents as well as it describes the needs, that are considered significant and whether those needs meet their expectations. Plenty of valuable information, which are related to the topic of foster parenting, were provided by foster parents, who gave their personal reflection, that was verified by brief research probe. The discussion stated in the end of the thesis summarizes the motives, which are frequently mentioned in the topic, including their possible difficulties as well as the thought about the reserves of current support given by the state and by accompanying organizations while satisfying the needs of foster parents.

In later life, the death of a family member occurs most often after a challenging time of family caring. It denotes a dramatic event in families’ lives, and involves intense feelings for all. To date, bereavement has mainly been investigated as an intrapersonal process from the perspective of family carers or widow/ers. Little is known about families’ experience when an adult member has died. A review of pertinent literature located only six adult family bereavement studies, which exposed the importance of family cohesion, communication and emotion, and found that family characteristics denote the background from which families make sense of the death. Despite these insights, a dearth of research exists about families’ lived relational world after a death late in life. Such knowledge is needed to better grasp bereaved families’ life-world and to discern their capacities and adversities, which shape their support needs. The purpose of this hermeneutic-phenomenological inquiry was to disclose meaning patterns and practices of families living with the loss of a close other. It included ten bereaved community-dwelling families, represented by widow/ers (mean age 80y), adult children, in-laws and grandchildren (n=30). Family was defined as a situated, relational involvement by those who feel close, and living with loss was seen as a process of changing relationships. A combination of in-depth family group (n=21) and solo interviews (n=16) were held six to 23 months after the death, and field-notes were written. The thematic and narrative analysis, embedded in a hermeneutic movement, involved reading, reflecting, and writing about gleaned data, fore-understandings, and emerging insights. Findings revealed that families’ life with loss is a world shared, and a world apart. Families collectively looked back to weave the death into their family narrative, and in so doing, constructed a story of a good death, compared-contrasted it with other deaths and events, and situated it within their multi-generational family context. Families lived with their loss by sharing-not sharing interpretations and daily lives. They connected via remembering, talking, spend-ing time, and enacting presence, but they disconnected for a variety of reasons. Families moved forward by continuing or reconstructing their family being and doing. While some families faced upheaval, others continued with little change. These findings need to be seen as situated, temporal constructs of prolonged researcher-participant engagements. They yield insights into families’ world based on the accounts of ten traditional families. Even so, this study adds a much needed empirical family perspective on bereavement. Family relations arose as interplay of different, contradicting forces at play, which moved members together and apart in their daily lives with loss. As such, it supports family models that emphasize the multivocal, relational, contextual, and continuously shifting nature of family health. It revealed that families hold an inherent capacity to make meaning of the death and enact family thereafter, and understand their relationships as resource. Thus, families may not need professional therapeutic interventions to redress their “functioning” or to avert “adverse” outcomes, but health promoting and relationship-strengthening care and services. Nurses can be helpful to families by facilitating meaning-making, strengthening family relations in a way that values multiple voices at play, and by supporting family transition and caring in light of present concerns.

Bakgrund: Amyotrofisk lateralskleros (ALS) är progredierande sjukdom som drabbar nervcellerna vilka styr muskulaturen med koldioxidnarkos vilket är den vanligast dödsorsaken inom tre till fem år. Det är vanligt att anhöriga agerar vårdare till den sjuke vilket kan leda till ökad stress och börda för anhörigvårdaren.   Syfte: Syftet var att beskriva anhörigvårdares upplevelser av att vårda närstående med ALS.Metod:Kvalitativ litteraturstudie av tio vetenskapliga artiklar från databaserna; PubMed, CINAHL, PsyHub, Web of Science som analyserades utifrån Fribergs femstegsmodell.  Resultat: Tre huvudteman identifierades samt ten subteman. Framtagna huvudteman var; Omvälvande Känslor, Att förändras i sin roll samt Strategier för att orka. Slutsats: Anhörigvårdare till närstående med ALS upplevde ständigt nya problem, ökad börda och fler uppoffringar. Förhållandet till den sjuke förändrades när relationen gick från anhörig till vårdare och känslan av normalitet blev svår att upprätthålla. Upplevelserna av extern vårdpersonal var splittrad med både goda och sämre erfarenheter. Familjecentrerat förhållningsätt bör användas inom vården för att anhörigvårdares behov ska mötas. / Background: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative neuromuscular disease affecting the motor neurons with eventual death due to respiratory failure within three to five years. It is common for family members or friends to nurse patients which can lead to increased stress and burden for the family carers.   Aim: The aim of this study was to describe family carers experiences of caring for a relative with ALS.Methods:Qualitative literature study of ten scientific papers taken from four databases; “PubMed”, “CINAHL”, PsyHub” and “Web of Science”. These were analysed using Fribergs five step model. Results: 3 main themes were identified alongside 10 subthemes. The main themes consisted of; Turbulent Emotions, The change in one’s role, Strategies to manage.  Conclusion: Family carers with relatives inflicted with ALS experienced increased burden of new responsibilities, increased strain, and forfeiture of one’s normality. The relationship with the afflicted individual changed from family member/friend to carer. Family carers found that the quality of care given by external care staff was inconsistent. Family focus care needs to be more prevalent to meet the needs of family carers.

Syftet med studien var att undersöka sjuksköterskors och skötares upplevelser av möten med patienter i psykiatrisk öppenvård.   Bakgrund – I psykiatrisk öppenvård möter sjuksköterskor och skötare många olika människor med individuella behov. Sedan tidigare forskning har det framkommit att patienters känsla av trygghet uppkommer genom faktorer som personalens inställning och empati. Relationen mellan personal och patient är viktig för patientens känsla av att bli tagen på allvar samt att bli bekräftad. För personer som lever med psykisk sjukdom är det viktigt med en långsiktig relation som grundar sig i förtroende och öppenhet. En god relation kan byggas om personalen kan befinna sig på patientens nivå och få patienten att känna sig viktig och betydelsefull. En fungerande allians tar tid att utveckla, men den utgör sedan en god grund för ett gott samarbete och har goda effekter på psykisk ohälsa.   Design – Kvalitativ design med fenomenologiskt förhållningssätt användes.   Metod – 8 intervjuer genomfördes med sjuksköterskor och skötare i psykiatrisk öppenvård på tre öppenvårdsmottagningar i norra Sverige under december 2015 – februari 2016 och analys gjordes med kvalitativ innehållsanalys.   Resultat – I psykiatrisk öppenvård ansågs relationen mellan vårdare och patient utgöra en stor grund, och fram för allt att det var en trygg relation. Denna trygghet kunde bland annat skapas genom vårdarnas tillgänglighet till patienterna. Fyra kategorier identifierades; Bemöta patienter, Upplevelser av att göra bedömningar, Upplevelser av att vara i patientens hemmiljö och Upplevelser av att arbeta i öppenvård.   Slutsats – Det arbete som sjuksköterskor och skötare utför genom möten med patienter i psykiatrisk öppenvård är betydelsefullt för så många människor med psykisk ohälsa. Genom att få ta del av vårdarnas upplevelser kan det bidra med ökad förståelse om deras betydelse för patienternas psykiska mående. Men samtidigt deras utsatthet då de kan försättas i problematiska situationer. Resultatet kan på så sätt bidra till att relevanta utbildningar och insatser kan identifieras och förhoppningsvis implementeras i verksamheterna. / The aim of this study was to investigate the nurses and assisted nurse mentals experiences of encounters with patients in psychiatric outpatient care.   Background – In psychiatric outpatient care nurses and assisted nurse mentals meets many different people with individual needs. Since previous research has shown that patients' sense of security generated by factors such as staff attitude and empathy. The relationship between staff and patients is important for the patient's feeling of being taken seriously and to be confirmed. For people living with mental illness, it is important to have a long-term relationship based on trust and transparency. A good relationship can be built if the staff can be at the patient level and make the patient feel important and significant. A working alliance takes time to develop, but it then forms a good basis for a good working relationship and has good effects on mental health.   Design – A qualitative design with a phenomenological approach was used.   Method – 8 interviews were conducted with nurses and assisted nurse mentals in psychiatric outpatient care in three outpatient clinics in northern Sweden during December 2015 - February 2016 and analyzed using qualitative content analysis.   Results – In psychiatric outpatient care the relationship between caregiver and patient was considered as a significant basis, and above all that it was a secure relationship. This security could, among other things be created by carers’ availability to patients. Four categories were identified; Meet patients, Make the right assessments, Be in the patient's home environment and Work in outpatient care.   Conclusion – The work that nurses and assisted nurse mentals carrying through in their meetings with patients in psychiatric outpatient care is important for so many people with mental illness. By getting the benefit of carers’ experiences it may contribute to a better understanding of their importance to the patients’ psychological being. But at the same time their vulnerability as they can be placed in problematic situations. The results can therefore contribute to relevant educations and initiatives can be identified and hopefully implemented in the clinics.

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In the literature, the experience of ‘care’ and ‘caregiving’ has been well documented and widely researched. Caregivers are recognized as people (family and friends) who provide unpaid substantial care for family members. Over time, research has increased awareness of caregivers as a distinct social group and has also contributed to caregiving being a widely recognized social issue. However, despite this increased awareness and continued concern for caregivers, much of the literature focuses on adult caregivers. As a result, the experiences of other caregiving populations, such as the youth and young adults, continues to be overlooked and underrepresented. Therefore, there is a need to explore and understand the unique experience of this population and how they give meaning to their experiences. Young caregivers (YCs) are children (5-18) and young adults (18-25) who provide substantial (unpaid) care for a family member who has an illness or disability (Stamatopoulos, 2016). Research on this population is scant and there exists many notable gaps in the literature in terms of diversity, age-based differences, programming and best practices for intervention. More specifically, there is a gap in understanding the experiences of young caregivers who are affected by progressive and incurable chronic brain diseases such as Alzheimer’s Disease or a Related Dementia. As such, this dissertation explores the experiences of YACs affected by ADRD, in terms of their personal experiences with ADRD (knowledge, dementia care and care practices), perceptions of their caregiving role and how they navigate the caregiving role. It builds on scholarship on young caregivers to broaden existing knowledge by using a phenomenological approach, known as Interpretive Phenomenological Analysis, to explore their caregiving experiences and the meaning they give to these experiences in-depth (n=12). It also aims to challenge the dominant assumptions about young caregivers by giving voice to this population by situating the young caregivers as the experts in their own lives. Findings indicate that the caregiving experience for YACs is complex, and situated within a larger socio-political context, which impacts the overall experience of care. Overall, the findings contribute to knowledge on the experiences of care among YACs and highlight the need for more inclusive research and practices on addressing caregiving among this group. / Dissertation / Candidate in Philosophy / This dissertation explores the lived experiences of young adult caregivers (YACs) caring for an older adult with Alzheimer’s Disease or a Related Dementia. Research on this group of caregivers is limited, particularly YACs (ages 18-25) who provide substantial (unpaid) caregiving for an older adult affected by Alzheimer’s or a Related Dementia. Therefore, a key aim of this research is to generate awareness and shed light on the nature of caregiving as experienced by this overlooked population of caregivers. As such, this dissertation aims to understand how young caregivers give meaning to, interpret and make sense of their caregiving experience. To understand the caregiving experience of YACs, I conducted interviews with 12 YACs from Canada and the United States and analyzed their perspectives in detail. The findings shed light on the many factors that shape the caregiving experiences. In addition, the findings show that more research is needed to understand the differences amongst young caregivers to better support their needs. In general, the research can contribute to existing knowledge on young adult caregivers, as well as relevant programs and policies.