Aim: The overall aim of the present thesis was to examine, develop and evaluate patient participation in emergency department (ED) for promoting the relief of suffering for patients in care relations, from the perspective of patients and caregivers. Method: The explorative studies (I, II) were based on reflective lifeworld approach and analyzed by phenomenographic method. Data were collected from interviews by patients (9) and caregivers (11) about their conception of patient participation in ED. The methodological study (III) performed analyses and were tested for content, construct and criterion validity as well as homogeneity and stability reliability. The sample for study (III, IV) consisted of 356 patients consecutively cared for in EDs in Sweden. In the evaluating study (IV) the questionnaire Patient Participation Emergency Department (PPED) was used. The statistical methods handled were Student’s t-test, one-way ANOVA and Spearman correlation. Findings: The patients’ conception of patient participation means: being acknowledged; struggling to become involved; and having a clear space (I). The caregivers’ conceptions of patient participation can be divided into three different descriptive categories: Caregivers offer the opportunity for participation, Patients demand participation and Mutual participation (II). A 17- item questionnaire was developed. Two separate factor analyses revealed a distinct four- factor solution which was labelled: Fight for participation, Requirement for participation, Mutual participation and Participating in getting basic needs satisfied. Criterion validity presented showed 9 out of 20 correlations equal or above 0.30. Cronbach’s alpha coefficient ranged from 0.63 - 0.84 and test- retest varied between 0.59 and 0.93(III).The results show that patient participation is low in two dimensions (Fight for participation, Participation in getting basic needs satisfied), reasonable in one dimension (Mutual participation), and high in one dimension, Requirement for participation (IV). Conclusions: Participation does occur on occasion when the circumstances are right despite international and national guidelines that lay down the need for patient participation. Patient participation in EDs is perceived when patients are in contact with caregivers and there is space for collaboration in situations of consistency. However, patient participation cannot be offered in a one-sided caring action. In collaboration patient participation contributes to the relief of suffering in the process of health and patients participate when they are allowed to be the point of departure for caring. However, the results point to a lack of strategy for patient participation and for increased patient participation to take place improvements in external organization requirements are required. The results indicate an amplified clarity in how patient participation can be understood for EDs, in education and community and a scientific tested instrument has made it possible to evaluate patient participation.

The extensive suffering related to a complex life situation with bipolar disorder and the reported difference between care needs and the needs that are actually met implicates that there are still questions about management of life with bipolar disorder that need to be answered. The present study therefore aims to describe the meaning of the conditions that enable a good life with bipolar disorder. Ten persons, six women and four men, (aged 30 – 61), diagnosed with bipolar disorder were interviewed. A reflective lifeworld perspective based on phenomenological philosophy was used. The findings present the essential meaning of the conditions that enable a good life with bipolar disorder as a dependence that empowers, which is further described by its constituents: “turning the course of life”, “protecting oneself from running out of energy”, “being needed”, “being oneself through reliable others”, “personal landmarks for navigating through life”. A voluntary chosen dependence, as described in the present study, is a new approach of care that enables a good life with bipolar disorder, while enhancing own power, freedom and control. The conditions that enable a good life with bipolar disorder are more than separate supporting measures. Therefore a holistic perspective is preferable while providing care for individuals with bipolar disorder.

Background: Each year approximately 30 000 people suffer from stroke in Sweden, often with substantial mental and physical consequences. Those who suffered from stroke handled the situation by mourning what they had lost and by accepting their changed body and life situation. For those who provide care for people who has suffered a stroke help and support was required. The caring science perspective was based upon caring and suffering. Aim: The purpose of this study was to describe family caregivers’ experiences of caring for persons who had suffered a stroke. Method: The method consisted of a systematic review with a descriptive synthesis and an inductive approach. Results: The analysis resulted in four major themes: alienation, dependency, change and control. Alienation was based on feelings of isolation and abandonment. Through the need for support from others and a new responsibility dependence was experienced. Change involved both a change of roles and the loss of independence. Lack of control resulted in feelings of uncertainty. In order to regain control methods to manage the life situation was used. Conclusions: Family caregivers experienced the caring for the person who had suffered a stroke as a responsibility that was forced upon them and the lack of support from the health care services contributed to negative experiences. By using coping strategies to manage the life situation family caregivers accepted the new life situation.

Background: Patients’ recovery from surgery differs when they are in a hospital setting or at home. However, an often forgotten aspect of post-operative ambulatory care is the patients' recovery at home following ambulatory surgery.Aim: To explore and describe the patients’ experiences of recovery at home following the ambulatory surgery procedure.Method: A systematic review of 7 qualitative studies in English with pre-specified criteria was conducted. An overview of qualitative evidence derived from the 17 identified main themes across the 7 primary studies was analyzed.Result: Seven thematic analysis themes were identified as being core to the patients’ experience during recovery process at home: physical symptoms, a period of regaining pre-operative functions, psychological effects, the surgical wound, delayed recovery process, social support, and the sick-role condition.. These seven themes were described patient's experiences at home following ambulatory surgery from early stage of recovery to the time of getting back to normal life.Conclusion: Recovery at home following ambulatory surgery seemed to be challenging, a quality self-care at home was lacking in the form having full control and knowledge about symptoms; adequate information, education and medication during self-care management; sufficient support by carer and nurses; and enough time-off for recovery.

Bakgrund: Elevers fysiska aktivitet minskar i relation till ökad skärmtid. WHO:s rekommendation för barn och ungdomars fysiska aktivitet är 60 minuter per dag. Rasterna spenderas ofta framför skärmar istället för att vara fysiskt aktiva. Skolsköterskor är verksamma inom elevhälsan som ska verka hälsofrämjande för elever och deras hälsa. Elever önskar själva ha hälsosamma vanor och ser hälsosamtalen med skolsköterskor som ett tillfälle där de har möjlighet att öka sin kunskap och få stöd. Self-efficacy, interpersonella influenser och situationsbundna influenser är betydelsefulla aspekter för elevers fysiska aktivitet. Syfte: Att beskriva skolsköterskors erfarenheter av hälsofrämjande arbete gällande elevers fysiska aktivitet. Metod: En kvalitativ intervjustudie med induktiv deskriptiv ansats genomfördes med 11 skolsköterskor och analyserades genom en innehållsanalys. Resultat: Skolsköterskors erfarenheter av hälsofrämjande arbete gällande elevers fysiska aktivitet handlar om att hantera hinder och möjligheter för elevers fysiska aktivitet. Detta beskrivs som: Att utmanas i sin roll och Att söka samarbetspartners. Slutsats: Skolsköterskor erfar att främja elevers fysiska aktivitet handlar om att hantera hinder och möjligheter för det. Kunskapsutveckling avseende skolsköterskors arbete med att främja elevers fysiska aktivitet kan bidra till utvecklingen av verktyg för att stödja detta arbete samt att utvecklingsområden kan identifieras och belysas. / Background: Pupils physical activity decreases in relation to increased screen time. The WHO`s recommendation for children and adolescent’s physical activity is 60 minutes per day. The school breaks are often spent in front of the screens instead of being physically active. School nurses are active in student health and work health promoting for students and their health. Students wish to have healthy habits and see the health dialogues with school nurses as an opportunity to increase their knowledge and obtain support. Self-efficacy, interpersonal influences and situational influences are important aspects of pupil’s physical activity. Aim: To describe the school nurse's experiences of health-promoting work regarding pupils’ physical activity Method: A qualitative interview study with inductive descriptive approach was completed with 11 school nurses and analyzed by a content analysis. Results: School nurses' experiences of health-promoting work regarding pupil’s physical activity include dealing with obstacles and opportunities for pupils’ physical activity. This is described as: Being challenged in their role and seeking cooperation partners. Conclusion: School nurses experience´s of promoting students' physical activity is about managing obstacles and opportunities for it. The development of knowledge regarding school nurse's work to promote student´s physical activity can contribute to develop tools to support this work, and that development areas can be identified and highlighted.

Aim: The overall aim is to develop knowledge about learning to live with diabetes.   Methods: All four studies have been carried out within the caring science and using a life-world phenomenological approach. Study (I): data was collected through written narratives from seven patients with insulin treatment. Studies (II and III): data was collected through interviews with twelve patients with diabetes. Study (IV): Data was collected from four groups and two individual interviews with sixteen diabetes nurses. The method for the analysis can be described as a dialectic process, beginning with the whole, analyzing its parts, and then reconstructing the whole in order to understand the essence of the phenomenon.   Main Findings: The result showed that patients’ experiences of the most obvious meanings of the phenomenon of being stricken by diabetes (I) are the fight against becoming your illness, a wish that everything would be as usual and that the new situation should only be natural. Furthermore, after having been diagnosed with the illness, the results demonstrated two themes that were particularly important in learning to live with diabetes. These were your own responsibility for gaining knowledge in order to incorporate the illness into your life and to find a balance between fear and control (II).  As support for the learning (III), reflection over the learning and experiences has a crucial role for a new understanding of health processes. Insight into your own responsibility was a key factor for this reflection. To be able to give support (1V), the diabetes nurse must adopt a reflecting, self-critical attitude with an insight that the responsibility for learning lies with the patient and that the role for the diabetes nurse is to encourage and challenge the patient to self-reflection and taking responsibility on the basis of individual goals and pre-requisites. To give support in this way, the diabetes nurse must downplay the medical requirements for control and make more use of his/her medical competence to ask reflection-triggering questions based on a life-world perspective.   Conclusion: Based on the patient’s life-world, an understanding is created that supports learning, which thereby can reduce the influence of the illness on the patient's life.  This understanding makes it possible to incorporate the illness into the patient's life and create a balance between fear and control.

Bakgrund: Diabetes mellitus är en folksjukdom som kan leda till tidig död, främst på grund av hjärt- och kärlsjukdom. Diabetes mellitus har två typer av sjukdomar, vilket är typ ett och två. Båda är kända med förhöjda blodsockernivåer. Diabetes mellitus typ två handlar om insulinresistens och delvis insulinbrist. Sjukdomen kan yttra sig med två typer av komplikationer, nämligen mikrovaskulära och makrovaskulära. Behandlingen av Diabetes mellitus typ två är främst medicinering, kost och motion som förändrar livsstilen. Här är egenvård mycket viktigt och sjuksköterskan måste undervisa och informera på rätt sätt. Syfte: Syftet med studien är att beskriva patientens upplevelse av att leva med diabetes mellitus typ två. Metod: Metod som används är en litteraturöversikt med nio vetenskapliga artiklar. Datainsamlingen gjordes med sökord i databaserna CINAHL och Medline. Resultat: Resultatet visar att patientens upplevelser av att behöva göra förändringar i livsstilen handlar om att få stöd och känna hopp i framtiden i förhållande till diabetes mellitus typ två. Kost- och motionsförändringar påverkar patientens upplevelser och känslor. Patienten kan även ha emotionella upplevelser vid diabetes mellitus typ två, vilket kan vara känslor som skuld och skam. I det här läget ska patienten acceptera sjukdomen. Patienten kan ha upplevelser som ånger, motivationsbrist, hopplös, utmaning, ångest, skuld, skam och svårt att acceptera sjukdomen.y Diskussion: Patienten med diabetes mellitus typ två bör ändra sin kost och motion för att kunna få en bättre hälsa. Samtidigt ska sjuksköterskan inte glömma bort patientens upplevelser som kan leda till olika konsekvenser. Kost och motion har varit en utmaning för vissa patienter i livsstilen, som kan associeras med livslidande.

Bakgrund: Sjuksköterskors välbefinnande på arbetsplatsen är av stor betydelse för både patientsäkerheten såväl som för sjuksköterskors retention i vården, där deras motivation för att vårda utgör en central roll. Syfte: Syftet är att beskriva sjuksköterskors upplevelser av att finna motivation till att vårda. Metod: Den valda metoden är en beskrivande litteraturstudie med ett underlag om elva vetenskapliga artiklar. Resultat: Resultatet omfattar två teman med två subteman vardera, vilka samtliga uppmärksammar upplevelser därigenom sjuksköterskor finner motivation till att vårda. Temat Betydelsen av meningsfullhet innefattar sjuksköterskors upplevelser av att få hjälpa patienter genom vårdandet samt upplevelser av att själva få något tillbaka av detta. Temat Betydelsen av en fungerande arbetsgrupp belyser sjuksköterskors behov av stöd från kollegor, samt vikten av att ständigt utvecklas professionellt och som person genom sitt vårdande. Slutsats: Sjuksköterskorna upplevde att de fann motivation till att vårda av att få vara till hjälp för en annan människa, samt genom att få något meningsfullt tillbaka av den givna vården. Sjuksköterskorna betonade vidare vikten av att få stöd från kollegor samt möjligheten att få utvecklas för att bibehålla sin motivation i vårdandet. Implementering av dessa motiverande aspekter för att vårda kan således bidra till ett förbättrat välbefinnande samt retention bland sjuksköterskor. / Background: Nurses wellbeing in the workplace is paramount for both patient security as well as for nurse retention, in which their motivation to nurse plays an important part for them to keep nursing. Aim: The aim of the study was to describe nurses’ experiences of finding motivations to nurse. Method: A descriptive literature review based on eleven articles in caring science. Result: The result contains two themes in which there are two subthemes each. The themes as well as the subthemes aim to describe experiences that help nurses find motivation to nurse. The theme Importance of meaningfulness describes nurses’ experiences of being able to help patients and receiving something back through their nursing. The theme Importance of a functioning working team describes the nurses need for social support from their colleagues, and their strive for constant development as a person as well in the nursing profession in order to be motivated to keep nursing. Conclusion: Nurses find motivation to nurse by being able to help another person and receiving something meaningful through their care. Furthermore, nurses stressed the need for receiving support from their colleagues as well as having opportunity for personal and professional development to keep their motivation to nurse. Implementation of these motivational aspects in nursing care can therefore contribute to nurse’s wellbeing as well as for their retention in the nursing profession.

Bakgrund: Tvångsåtgärder som fenomen visar sig i tidigare studier vara en företeelse som av både sjuksköterskor och patienter upplevs negativt, men som inte helt kan tas bort. Tidigare studier visar att vårdrelationen är det som utgör basen i vårdandet och kan vara en avgörande faktor genom hela förloppet att utföra tvångsåtgärder. Syfte: Att beskriva specialistsjuksköterskors erfarenheter av den vårdande relationens betydelse relaterat till tvångsåtgärder inom rättspsykiatrisk slutenvård. Metod: Data insamlades via åtta semistrukturerade intervjuer på ett rättspsykiatriskt sjukhus i Mellansverige. Samtliga deltagare hade specialistutbildning inom psykiatrisk vård. En kvalitativ innehållsanalys med induktiv ansats användes. Stöd av fenomenologisk hermeneutisk analysmetod togs i framskrivandet av temat. Resultat: Resultatet redovisas i fem kategorier: Att känna en annan människa, Att våga ha tillit till sina beslut, Att lära av varandra, Att finnas där, Att dra nytta av samarbetet. I kategorierna finns totalt elva tillhörande subkategorier. Kategorier och subkategorier bildade tillsammans temat Att bygga en bro för att korsa det hotande vattnet tillsammans. Slutsatser: Den vårdande relationens betydelse relaterat till tvångsåtgärder visar sig vara viktig för att förebygga tvångsåtgärder såväl som i utförandet och i efterförloppet. Den vårdande relationen är fundamental för att se hela människan och nå en förståelse för personen för att kunna tillgodose bästa möjliga vård.

SAMMANFATTNING Introduktion: I Sverige drabbas årligen cirka 300 barn under 18 år av cancer, som även är den vanligaste dödsorsaken hos barn. Det innebär många tuffa behandlingar på sjukhus. Familjen är barnets viktigaste mikrosystem, vilket spelar stor roll dess samspel med uppväxtens omgivande miljö. Därmed är det viktigt att ta reda på familjens erfarenheter av ett cancersjukt barn. Syfte: Syftet med denna studie är att beskriva familjemedlemmars erfarenheter av ett cancersjukt barn i familjen. Metod: Beskrivande design med allmän kvalitativ litteraturöversikt. Huvudresultat: Sju teman identifierades: föräldraskapets utmaningar, påverkan på parrelationen, påverkan på arbetet, påverkan på vardagen, syskonens påverkan, psykisk påverkan och vårdpersonalens betydelse för familjen. Föräldrarna delade upp sig, en var alltid på sjukhuset och den andra tog hand om hemmet och syskon. Det hade ingen tid för att ta hand om relationen till varandra. Vardagen förändrades, barnet kunde inte längre gå till skolan samt inte umgås med kompisar som tidigare. Syskonen till cancersjuka barnet upplevde att det inte fick lika mycket uppmärksamhet. Alla familjer blev påverkade psykisk, bland annat av rädsla och oro. Vårdpersonalens betydelse för familjen, visade sig familjerna ha delade meningar om. Slutsats: Denna litteraturöversikt visar att det är en stor påfrestning på familjen på många olika sätt då ett barn i familjen får cancer. För att hantera situationen använde familjer flera olika sorters copingstrategier. Alla tre olika typerna av copingstrategier: problemfokuserad-, emotionell- och meningsfokuserad coping sågs användas. Att sjukvårdspersonalen stöttar hela familjen under den tuffa tiden är viktigt för att familjen ska få så bra erfarenheter som möjligt. / ABSTRACT Introduction: In Sweden, 300 children under age 18, are yearly affected by cancer. This implies tough treatments in hospital. Cancer is the most common death in children. The family is the child's most important microsystem. Therefore, it's important to find out the family experiences of a child with cancer.  Aim: The aim of this study is to describe family members´ experience of a child with cancer in the family. Method: Descriptive design with general qualitative literature review. Result: Seven themes identified: the challenges of parenthood, the impact on the relationship, the impact on work, the impact on everyday life, the siblings' impact, psychological impact and the importance of care staff for the family. The parents split up, one was in the hospital and one took care of the home. There was no time to take care of the relationship. Everyday life changed, the child could no longer go to school and could not spend time with friends as before. The siblings felt that it did not receive as much attention like before. All families were mentally affected. The importance of care staff for the family turned out to be shared by the families.  Conclusion: This literature review shows that it's a great strain on the family in many different ways when a child gets cancer. Problem-focused, emotional and meaning-focused coping were used by the family. That the care staff supports the whole family during the tough times is important for the family to have good experiences.