The overall aim of this thesis is to gain a better understanding how people with dementia and their spouses experience dementia over time, especially the impact it has on their inter-personal relationships and patterns of everyday life. Data were collected using separate semi-structured interviews with 20 persons with dementia and their spouses of 6 monthly intervals over an 18-months period (132 interviews in total), and analysed using constructivist grounded theory. Analysis suggested that whilst spouses are aware of and acknowledge the diagnosis of dementia, they do not routinely talk about it but rather the focus of their combined efforts is on making life as meaningful as possible. To do this couples, rather than individuals, actively ‘work together’ to create a ‘nurturative relational context’ in order to sustain the quality of their relationship, and maintain the self-image and sense of agency of the person with dementia. In order to create a ‘nurturative relational context’ couples continued to ‘do things together’ for as long as possible by understanding complementary roles underpinned by a mutual appreciation of each others contribution in a way that builds upon the remaining strengths of the person with dementia. Their focus is therefore on ‘couplehood’ as much as ‘personhood’. An analysis of the complete data set identified three temporally sequenced but overlapping phases of the experience of couplehood termed ‘sustaining couplehood’, ‘maintaining involvement’, and ‘becoming alone’. ‘Sustaining couplehood’ had the primary goal of ensuring that the spuses’ ‘work’. This involved four interrelated sets of activities: talking things through, in order to ensure good communication and acknowledge and value differences; being affectionate and appreciative by demonstrating continued attractiveness to their spouse; making the most of things by enjoying everyday pleasures, looking for positive interpretations of events and focussing on the present (living for today); and finally, keeping the peace by being aware of potential points of friction and not responding to difficult behaviour. Both the person with dementia and the non-affected spouse were active strategies in the above process. In addition both spouses worked to ‘maintain the involvement’ of the person with dementia by ensuring that they had an active role to play. However, despite their efforts, eventually the non-affected spouse took on an increasing role and this occurred in a number of ways, either by the person with dementia consciously ‘handing over’ responsibility or more passively ‘letting go’, or by the non-affected spouse ‘taking over’. ‘Sustaining couplehood’ and ‘maintaining involvement’ often occurred simultaneously but the relative emphasis changed over time as ‘sustaining couplehood’ became more difficult and increasing effort was expended in ‘maintaining involvement’. As this occurred the data suggested that the non-affected spouse became increasingly ‘alone’ as the dementia progressed. This process has yet to be fully explored, however, it is clear that for spouses a complete understanding of the dementia experience is not possible without consideration of ‘couplehood’.

Today patients are more aware of their rights regarding their own care. They are more informed, more engaged and have more and individual requirements, which leads to increased demands for information and participation increases. The Health Act sets out the patients´ right to participation. Participation increases patient satisfaction with care, promotes healing and increases adherence to health care advise. The patient doesn´t always experience participation in their own care to the extent they wish, which suggests that nurse’s does not always succeed in getting the patient involved. The purpose of this study is to describe factors that are important for patient participation in nursing care in a nurse- and patient perspective. Nine research articles were analyzed with qualitative content analysis. The analysis resulted in two themes: health care relationships and communication. Through various acts of nursing care, patients experienced themselves as being seen and confirmed. Patients experienced a sense of security and trust, which is the essence of a trusting relationship, which in turn is the basis for caring and patient participation in their own care. Patient participation requires a sophisticated interaction between nurse and patient, a quest of a safe relationship that can lead the patient to see themselves seen and confirmed.       Keywords: patient participation, nurse-patient relationship, nurse, care

Syftet med denna studie var att beskriva vilka faktorer som kan påverka sjuksköterskans möjligheter att handleda sjuksköterskestudenter under deras verksamhetsförlagda utbildning. Sjuksköterskan handleder studenter dagligen i klinisk praktik. Sjuksköterskan ska kunna hantera sitt arbete och samtidigt vara handledare för studenter. Studien är en litteraturstudie med en beskrivande design i vilken fjorton artiklar granskats. Resultatet visade att i tio av de fjorton artiklarna togs negativt påverkande faktorer upp såsom hög arbetsbelastning och otillräcklig avsatt tid för lärande och återkoppling med studenten i den kliniska miljön. Positiva faktorer var att få stöd från kollegor och från Högskolan. I elva artiklar framkom att högre vetenskaplig utbildning och utbildning i handledning underlättar för handledare att kunna ge studenter en stimulerande klinisk praktik. I sex av de fjorton artiklarna visade resultatet behovet för Högskolan att ha en god samordning med handledare och ge information om studenters kunskap och uppsatta mål med verksamhetsförlagd utbildning. / The purpose of this study was to describe the factors that may affect nurses' ability in supervision of  nursing students during their clinical training. Nurse´s precepts students in daily clinical practice. The nurse should be able to manage their work as well as being preceptor for students. The study is a literature review with a descriptive design in which fourteen articles were reviewed. The results showed that in ten of the fourteen articles negative factors were described as high workload and insufficient time allocated for learning and feedback to the student in the clinical environment. Positive factors were described as received support from colleagues and from the School of Nursing. It appeared in eleven articles that factors such as higher scientific education and a training in supervision facilitated the preceptoring nurses  in their task to give students a stimulating clinical practice. In six of the fourteen articles results showed a need for the School of Nursing to have a good coordination with the preceptor and to provide information on students' knowledge and goals of the clinical training.

Syftet med denna litteraturöversikt var att kartlägga vilka upplevelser patienter efter en hjärtinfarkt har av egenvården, dvs. vårdåtgärder som patienterna själv bedöms kunna utföra. Metoden som användes var en litteraturöversikt där totalt femton kvalitativa artiklar användes i resultatet. De databaser som användes var PubMed och Cinahl. Resultatet visade att familjens stöd var till stor hjälp vid praktiseringen av egenvård. Patienterna upplevde att överlevnaden efter en hjärtinfarkt gav dem en stor motivation till att följa egenvårdsdirektiven och ta vara på sitt liv. Att ta in roliga aktiviteter i egenvården gjorde det lättare att lyckas med egenvården. Däremot var tidsbristen ett stort hinder för att klara egenvården när patienterna började bli friska nog att återvända till sina arbeten. Slutsatsen är att uppföljning av patienternas tillämpning av egenvård behövs för att förhindra att de slutar med den. Det är även viktigt att få uppmuntran av sjuksköterskan till att utföra egna roliga aktiviteter och att få stöd med vad de kan göra. Det är också av stor vikt att sjuksköterskan medverkar till att involvera familjen i patientens egenvård. / This literature study aims at mapping what experiences myocardial infarction patients have from self care, i.e. care that patients are judged to accomplish. The method used was a literary survey where a total of fifteen qualitative articles were used in the result. The databases used were PubMed and Cinahl. The result showed that family support was of great help to be successful with self care. Patients experienced that surviving a myocardial infarction gave them a motivation to follow self care directives and take care of their life. It proved easier to succeed with self care if patients enjoyed their activities. When the patients felt healthy enough to return to work, lack of time was an obstacle to manage self care. The conclusion is that follow up on patients self care is needed to prevent them from quitting. It is also important that their nurse encourages both enjoyable activities and family involvement for the patients to manage self care. The patients also need help and support from their nurse when it comes to what activities they can try.

The purpose of this study was to investigate registered nurses experiences about the current model for triage at the emergency department at Uppsala University Hospital. The study is descriptive with qualitative approach. The data collection was made in the form of semi structured interviews. The interviews took place at the emergency department. The sample consisted of eight registered nurses with varying work experience of emergency care. The interviews were transcribed and analyzed. The content analysis resulted in 14 categories and four themes. The main result contains both positive and negative experiences concerning registered nurses situation when working with team triage. Team triage has improved the work in many aspects: it runs more smoothly and inspires to a good working climate. At the same time the informants experienced the lack of guidelines on how team triage should be conducted. Working in team has improved the cooperation with the physicians. An important factor to this is good communication. However, numerous of the informants felt that they were of no use when working in team. It was also a lack of interest from the physicians of working in team with registered nurses. Further research is required on this topic to develop and improve the way to work with team triage.

To sort, is the meaning of the word “triage”. Triage is used at emergency departments to facilitate prioritization of patients according to the urgency of the chief complaint. The aim of this study was to investigate how the nurses experience the triage model at the emergency department at Uppsala university hospital. Twelve nurses were interviewed. The mean age was 40 years and the mean work experience was three years and four months. An interview guide was used, consisting of questions about triage, collaboration and work situation. The nurses perceived that triage supports assessment and prioritization of patients. Different triage models were used depending on the nurses’ level of triage-education, which was perceived as problematic. The nurses perceived safety when triage was performed together with the physician. The level of collaboration, between the nurses and the physicians, was experienced to be person-dependent. The importance of good communication between nurses and physicians were highlighted. Triage supports the assessment and prioritization of patients. A standardized triage model would increase the quality of care. The collaboration between nurses and physicians could be improved if they receive the same information and education about triage. Improved communication will facilitate the collaboration. Physicians should participate in the triage process.

The purpose of the study was to describe how care givers experience working with people who suffer from dementia and acting out behaviour and to illustrate the importance of the care givers approach. Sixteen caregivers were interviewed from different nursing homes in the middle of Sweden. The interviews were analyzed with qualitative content analysis. The result is divided into two content areas. The analysis of the first content area, care givers experiences of meeting people with dementia and acting out behaviour, resulted in three categories, which deals with the approach. The categories were; to be insecure, to feel a challenge and to be secure. To have co-workers nearby resulted in feeling secure. A challenge was to make the person suffering from dementia feel well once again. To be inexperienced resulted in insecurity among the care givers. The second area of content was, the care givers description of the value of a good approach when meeting people suffering from dementia and acting out behaviour. The analysis of that content area resulted in four categories; to be clear, to be calm, to be experienced and to be accepted. To be calm and use few words was successful. To have knowledge and to be appreciated made the care giving work easier. The result of the study illustrates different approaches from care givers in their contact with patients with dementia and how care givers experienced that contact. / Syftet med studien var att beskriva omvårdnadspersonalens upplevelser av att möta personer med demenssjukdom och utåtagerande beteende samt att belysa betydelsen av omvårdnadspersonalens bemötande. Sexton omvårdnadspersonal från olika äldreboenden i Mellansverige intervjuades. Intervjuerna analyserades utifrån kvalitativ innehållsanalys. Resultatet är uppdelat utifrån två innehållsområden. Analysen av det första, omvårdnadspersonalens upplevelser av att möta personer med demenssjukdom och utåtagerande beteende resulterade i tre kategorier som behandlar mötet. Dessa var; att vara osäker, att känna en utmaning och att vara trygg. Att ha arbetskamrater nära sig ingav trygghet. En utmaning var att få den demenssjuke att må bra igen. Att vara oerfaren gjorde att omvårdnadspersonalen kände sig osäkra. Det andra innehållsområdet var; omvårdnadspersonalens beskrivning av betydelsen av bemötandet i vården av personer med demenssjukdom och utåtagerande beteende. Analysen av det innehållsområdet resulterade i fyra kategorier; att vara tydlig, att vara lugn, att vara erfaren och att vara accepterad. Att vara lugn och att använda få ord hade framgång. Ha kunskap och att vara uppskattad underlättade i omvårdnadsarbetet. Resultatet av studien illustrerar omvårdnadspersonalens olika förhållningssätt i bemötandet av patienter med demens och hur omvårdnadspersonalen upplever dessa möten

Christina Thulin-Andersson Hur mår undersköterskor i förhållande till de arbetsuppgifter och arbetsvillkor som de ställs inför inom äldreomsorgen? Hur påverkas deras self-efficacy? VT 2007 Antal sidor: 27 ___________________________________________________________________________ Studiens syfte är att bidra med kunskap till och förståelse för vilka faktorer och fenomen som kan vara avgörande för utvecklingen av självbemästring för undersköterskor inom äldreomsorgen. Uppsatsens forskningsfråga formuleras på följande sätt: Hur kan självbemästring påverkas av de arbetsvillkor och arbetsuppgifter undersköterskor ställs inför inom äldreomsorgen? Studiens frågeställning besvaras med hjälp av intervjustudie. De intervjuade var sex undersköterskor med varierande ålder och de har arbetat olika lång tid inom äldreomsorgen Resultaten visade att förmågan att förmedla och att ta emot kunskap inför olika arbetsuppgifter och arbetsvillkor, har en påverkan för utveckling av självbemästring. Fenomen som handlingsfrihet, trivsel på arbetsplatsen och personalchefens tillgänglighet påverkar även det undersköterskors självbemästring. Den viktigaste slutsatsen är att avsaknad av närvarande personalchef förekommer, vilket innebär en brist i att motivera undersköterskor, personlig tillgänglighet och tillgänglighet i skilda situationer.

Sammanfattning Syftet med studien var att beskriva en grupp (n=28) äldre äldres (<80) känsla av sammanhang (KASAM) dels vid inflytt till äldreboendet och dels efter att de bott på äldreboendet i nio månader. Därefter jämföra om det skett någon förändring av deras KASAM. Studien genomfördes som en kvantitativ och prospektiv studie med jämförande ansats. En enkät delades ut vid två tillfällen, dels när de nyligen hade flyttat in på det nyöppnade äldreboendet och dels efter att ha bott på äldreboendet i nio månader. Resultatet visade att medianen av de äldre äldres KASAM vid inflytt till äldreboendet var 133,5 och efter nio månader var 163. Samtliga deltagare (n=28) i studien ökade i KASAM efter att ha bott på äldreboendet i nio månader jämfört med vid inflytten till äldreboendet. Nyckelord: KASAM (Känsla av sammanhang), äldre äldre, äldreboende

Abstract: Job satisfaction has great significance for nurses. The job is very demanding and requires a great deal of responsibility. Low job satisfaction and organisation changes affect their work negatively. The aim of the study was to investigate the nurses’ job satisfaction and job situation. Legitimate nurses at a medicine department of a hospital situated in the middle of Sweden were interviewed for this purpose. The study is descriptive and the qualitative approach has been used. The data was analysed with content analysis as described by Graneheim and Lundman. The study investigates the factors affecting nurses’ experiences as far as job satisfaction and job situation are concerned. The nurses’ opinions on what should be done to improve their work environment are also discussed in the study. The result shows that the nurses’ job satisfaction and job situation is affected by the collaboration between the colleagues and the management, as well as job related stress and work environment.