Introduktion: Under pandemins första våg av SARS-CoV-2 inverkade ett flertal faktorer på den vård och omvårdnad som gavs till kritiskt sjuka i covid-19. Intensivvårdssjuksköterskorna arbetade under ansträngda förhållanden och de anhöriga fick inte besöka avdelningarna, vilket lämnade patienterna i en utsatt position. Hur situationen påverkat och hanterats av de berörda kan ge information om hur intensivvården kan förbättras och vad som är viktigt att prioritera under svåra omständigheter. Syfte: Att beskriva patients och anhörigs erfarenheter av intensivvårdskrävande sjukdom till följd av Covid-19 och hur det påverkat dem efter sjukhustiden. Metod: En enskild instrumentell fallstudie med flera underenheter användes som metod, där semistrukturerade intervjuer analyserades med kvalitativ innehållsanalys. Resultat: Två kategorier erhölls ur analysen: ”Inget var som vanligt” som visar hur insjuknandet och sjukhustiden var och upplevdes, samt ”Vägen tillbaka” som beskriver hur paret påverkats av sjukdomstiden i olika avseenden och hur de erfarit efterförloppet. Studien visar att den personcentrerade omvårdnaden blev lidande till följd av tids- och personalbrist samt frånvaro av anhörigkontakt mellan intensivvårdssjuksköterska och anhörig. Däremot skapades goda relationer mellan anhörig och ansvariga läkare med hjälp av digitala kommunikationsverktyg trots avsaknad av fysiska möten. Trots ett gott stöd från ansvariga läkare utvecklade anhörig psykiska besvär efter sjukhustiden, och en avsaknad av stöd i efterförloppet framkom. Slutsats: Tid och resurser avsatta för att både vård och omvårdnad ska kunna utföras med god kvalitet, och för att stärka ett personcentrerat förhållningssätt måste säkras vid speciellt krävande omständigheter. Det finns potential för användandet av digitala kommunikationsverktyg för att möjliggöra ett personcentrart förhållningssätt i situationer där anhöriga av olika anledningar inte fysiskt kan närvara på IVA, och detta bör utforskas ytterligare. Uppföljningen av patient och anhörig efter kritisk sjukdom bör också utvecklas och stärkas. Sammantaget skulle dessa faktorer kunna stärka det personcentrerade förhållningssättet, minska anhörigas stress, förbättra omvårdnadskvalitet för patienten samt minska psykiska symtom i efterförloppet.

Introduktion: Smärta är vanligt förekommande i livets slutskede och är en av de faktorer inom palliativ vård som skapar mest oro och ångest hos patienten men även närstående. Cancer är ofta associerat med smärta, men smärta förekommer även vid en rad andra sjukdomar i livets slutskede såsom vid hjärtsvikt, njursvikt och kronisk obstruktiv lungsjukdom. Förekomsten av smärta ökar ju närmare livets slutskede en patient befinner sig och 25 % av patienterna upplever en otillräcklig smärtlindring under sista veckan i livet. Användning av intratekalbedövning kan ha en avgörande betydelse som smärtlindringsmetod i livets slutskede för att minska smärta, förbättra patientens autonomi och på så vis öka livskvalitén. Syfte: Att beskriva patienters och sjuksköterskors upplevelse av intratekal som smärtlindringsmetod i livets slutskede. Metod: En fallstudie med kvalitativ metod och induktiv ansats användes, där semistrukturerade intervjuer analyserades med kvalitativ innehållsanalys. Resultat: Totalt erhölls fem kategorier ur dataanalysen, vilka var: Bristande information och erfarenhet av intratekal blockad, Intratekal blockad som en sista utväg, Varierande effekt av intratekal blockad, komplikationer med intratekal blockad och Att uppleva självständighet och livskvalité. Slutsats: Denna studie visar på varierande effekter av intratekal blockad som smärtlindring till patienter i livets slutskede. För de patienter där det fungerar väl är det en god smärtlindringsmetod som ger en ökad självständighet och livskvalité. Smärta är mångdimensionellt och bör behandlas med flera komponenter, där patienten är i centrum och ett holistiskt synsätt ses över hela patienten. Intratekal smärtlindring bör vara ett alternativ i tidig planering för långvarig smärtproblematik och det behövs utbildning för vårdpersonal inom området.

Text in English / This qualitative psychobiographical study sets out to explore and describe the life of Sir Winston Churchill within the context of his lifelong experience with depression, his ‘Black Dog’. The aim of the research is to present a case for depressive realism with Churchill as the single case study. The reconstruction of Churchill’s life as a psychological narrative is contextualised within the theoretical framework of Alfred Adler’s Theory of Individual Psychology. Data was collated via biographical and life history material. Data was analysed by means of thematic analysis. Data trustworthiness and ethical considerations were adhered to. The findings of this study reveal that Churchill’s depression had positive gains of him striving to contribute to society, potentially demonstrating that depressive realism exists as a side-effect of depression. The significance of which, conceivably substantiates the idea that positive aspects of depression do exist, enabling a potentially more encouraging and constructive outlook for individuals suffering from depression. / Psychology / M.A. (Psychology)

This is a qualitative interpretive study undertaken through a case study design. The study was carried out to investigate the responsiveness of Social Studies teacher training curriculum towards democratic citizenship education (DCE) with two colleges of education (primary) in Botswana, and the University of Botswana. The following instruments were used as a means to gather data: individual interviews, group interviews, qualitative-questionnaire and document analysis. The participants for the study were drawn from colleges of education Social Studies lecturers and student-teachers with Social Studies as a major subject and the University of Botswana lecturers in the Faculty of Education. The study was inspired by the quest for democratisation of the school system in Botswana through a responsive curriculum. Botswana is dubbed a shining example of democracy, yet active participation of citizens in the national agenda is far to be admired. The best genesis for this enormous task is with teacher training because teachers play a pivotal role in transforming the society through the diffusion of requisite knowledge, skills, behaviours and attitudes. Thus, this argument positions this study to explore the responsiveness of teacher training curriculum at primary teacher training colleges towards DCE. This study was informed by the constructivist perspective on education and teaching. Constructivism is defined by Darforth and Smith (2005) as a broad set of interrelated theories that suggest that knowledge is human creation. This means that, the ideas, attitudes and practices referred to as constructivism are about how humans who learn by building knowledge cooperatively through social interaction and application of prior knowledge in a continual interpretation of ongoing experiences. Moreover, this explains that people explore events and environments, interact among themselves and confront situations and challenge they encounter. The findings of the study show that the teaching of DCE at colleges of education has not been successful as was expected. Firstly, according to the participants, the curriculum does not have adequate content on DCE. Secondly, the values of DCE which are capable of developing student-teachers to be effective citizenship education teachers are not well included in the syllabus. Thirdly, college lecturers believe in active methods of teaching for DCE but perform the opposite in their classes. Lastly, colleges have a lot of challenges that hamper effective transmission of DCE. These range from lack of appropriate educational material for DCE to college leadership that does not recognise the voices of the students in decision making. This study, however, recognises efforts made by colleges to train formidable Social Studies teachers for the transmission of DCE. The study elevates an argument that in-service teachers need support in their effort to transmit DCE to pupils in primary schools. Thus, in the light of the pervasive influence of findings from this study I recommend that policy makers and curriculum planners should consider updating lecturers about the type of Social Studies teacher they are expected to produce. Also I recommend that colleges should review their study materials to align them to the ideals of DCE, with a view to fill the gaps and deficiencies that exist in some topics. Lastly, the study concludes by raising an essential argument that with the current teacher training curriculum and classroom atmosphere in colleges of education, Botswana’s goal of training effective and functional citizenry is an illusion. / Curriculum and Instructional Studies / D. Ed. (Curriculum studies)

This is a qualitative interpretive study undertaken through a case study design. The study was carried out to investigate the responsiveness of Social Studies teacher training curriculum towards democratic citizenship education (DCE) with two colleges of education (primary) in Botswana, and the University of Botswana. The following instruments were used as a means to gather data: individual interviews, group interviews, qualitative-questionnaire and document analysis. The participants for the study were drawn from colleges of education Social Studies lecturers and student-teachers with Social Studies as a major subject and the University of Botswana lecturers in the Faculty of Education. The study was inspired by the quest for democratisation of the school system in Botswana through a responsive curriculum. Botswana is dubbed a shining example of democracy, yet active participation of citizens in the national agenda is far to be admired. The best genesis for this enormous task is with teacher training because teachers play a pivotal role in transforming the society through the diffusion of requisite knowledge, skills, behaviours and attitudes. Thus, this argument positions this study to explore the responsiveness of teacher training curriculum at primary teacher training colleges towards DCE. This study was informed by the constructivist perspective on education and teaching. Constructivism is defined by Darforth and Smith (2005) as a broad set of interrelated theories that suggest that knowledge is human creation. This means that, the ideas, attitudes and practices referred to as constructivism are about how humans who learn by building knowledge cooperatively through social interaction and application of prior knowledge in a continual interpretation of ongoing experiences. Moreover, this explains that people explore events and environments, interact among themselves and confront situations and challenge they encounter. The findings of the study show that the teaching of DCE at colleges of education has not been successful as was expected. Firstly, according to the participants, the curriculum does not have adequate content on DCE. Secondly, the values of DCE which are capable of developing student-teachers to be effective citizenship education teachers are not well included in the syllabus. Thirdly, college lecturers believe in active methods of teaching for DCE but perform the opposite in their classes. Lastly, colleges have a lot of challenges that hamper effective transmission of DCE. These range from lack of appropriate educational material for DCE to college leadership that does not recognise the voices of the students in decision making. This study, however, recognises efforts made by colleges to train formidable Social Studies teachers for the transmission of DCE. The study elevates an argument that in-service teachers need support in their effort to transmit DCE to pupils in primary schools. Thus, in the light of the pervasive influence of findings from this study I recommend that policy makers and curriculum planners should consider updating lecturers about the type of Social Studies teacher they are expected to produce. Also I recommend that colleges should review their study materials to align them to the ideals of DCE, with a view to fill the gaps and deficiencies that exist in some topics. Lastly, the study concludes by raising an essential argument that with the current teacher training curriculum and classroom atmosphere in colleges of education, Botswana’s goal of training effective and functional citizenry is an illusion. / Curriculum and Instructional Studies / D. Ed. (Curriculum studies)

En aquest treball exploratori s'estudien les conductes de cercad'informació a la web d'un total de sis participants (quatre estudiants de traducció en el seu primer any d'estudis de postgrau i dos traductors professionals amb tres i 15 anysd'experiència, respectivament). Atès que la necessitat de cercar, recuperar, utilitzar i generar informació depèn, entre molts altres factors, del tipus d'usuari i recerques documentals, aquest estudise centra en les cerques d'informació en línia realitzades a partir de la traducció de l'espanyol a l'anglès de dos textos dedivulgació científica. Els comportaments de recerca d'informació en línia dels participants de l'estudi s'analitzen per tant en relació a una sèrie de característiques textuals (encàrrec de traducció i text d'origen) i qualitats personals (nivell de coneixement sobre la temàtica de traducció, i nivell de coneixement i experiència tanten el camp de la traducció com en la recerca d'informació en línia). Tot i que s'han recopilat dades de tots els participants de l'estudi pel que fa a la primera tasca de traducció, les dades relatives a la segona tasca de traducció corresponen només als estudiants de traducció. / En este trabajo exploratorio se estudian las conductas de búsqueda de información en la Web de un total de seis participantes (cuatro estudiantes de traducción en su primer año de estudios de postgrado y dos traductores profesionales con tres y 15 años de experiencia, respectivamente). Dado que la necesidad de buscar, recuperar, utilizar y generar información depende, entre otros muchos factores, del tipo de usuario y búsquedas documentales, este estudio se centra en las búsquedas de información en línea realizadas a partir de la traducción del español al inglés de dos textos de divulgación científica. Los comportamientos de búsqueda de información de los participantes del estudio se analizan por tanto en relación a una serie de características textuales (encargo de traducción y texto de origen) y cualidades personales (nivel de conocimiento sobre la temática de traducción, y nivel de conocimiento y experiencia tanto en el campo de la traducción como en la búsqueda de información en línea). Si bien todos los participantes del estudio realizaron la primera tarea de traducción, solo los estudiantes llevaron a cabo la segunda tarea de traducción. / This multiple-case study explores the Web search behaviors of a total of six participants. These include a naturally occurring sample of four postgraduate translation trainees (in their first year of studies) who enrolled in an introductory course on technical and scientific translation, and two additional subjects (a PhD student of translation with three years of casual professional translation experience and a translation teacher with over 15 years of experience in the discipline) who participated in a pilot study conducted prior to the main study. Given that the need to seek, retrieve, use, and generate translation information depends on the type of users and the translation tasks performed, the study focuses on two specific tasks dealing with the translation of two popular-science texts from Spanish into English. In particular, the study examines the online search behaviors of all participants in relation to a number of translation task attributes (text type and translation brief) as well as user attributes (translation expertise, Web search expertise, and domain knowledge). While for the first task data was obtained from all six research participants, the second task was only carried out by the four translation trainees.

The modern hospice movement emerged in the 1960s as a grassroots social movement that attempted to restore an holistic and contextualised approach to the care of people at the end of life. This approach embraced the lived experience of the dying person at the centre of care across physical, emotional, social and spiritual domains of life. To achieve this, the care of dying people was largely removed from mainstream health care systems to promote more holistic and socially contextualised dying. In recent decades, the evolution of palliative care demonstrates the gradual return of palliative care services to the mainstream. It has been asserted that, in this process, palliative care services have progressively abandoned the social context of dying people, increasing instead an emphasis on "physical care [while] simultaneously de-emphasizing psychological, social and spiritual care" (Kellehear, 1999a, p.76). Kellehear and others have proposed that the repositioning of palliative care within mainstream health care systems has increased a focus upon illness and disease at the expense of health and wellbeing. Subsequently, conventional palliative care services have been criticised for not adequately locating end of life care within the social contexts in which death and dying take place. In an attempt to address this problem, Australian sociologist Allan Kellehear proposed an approach to end of life care that brought together the core concerns of palliative care with the principles and practices of health promotion (Kellehear, 1999b). Whilst their congruence is not immediately apparent, these two fields have been increasingly examined for their potential benefits in the provision of end of life care. In the current policy climate in Australia, there is an imperative to consider how end of life support services might be improved through adopting a health promoting palliative care approach. The aim of this study has been to investigate the integration of health promotion principles and practice by a selected palliative care service by examining the qualitative impact of this change on the organisation. Specifically, it endeavoured to identify the factors that advanced or impeded this integration by examining how the structures and processes of, and outcomes for, the organisation reflected a health promoting approach. To meet these aims, this study undertook an in-depth examination of the implementation of a health promoting palliative care model by a community based palliative care organisation. Based in a constructionist-interpretivist paradigm, a mixed-method (QUAL+quant), instrumental case study research design was utilised to capture multiple perspectives of the implementation process. Data collection comprised examination of 127 organisational documents, 32 in-depth interviews with staff, volunteers and consumers, 5 focus groups with staff and volunteers, and 25 carer questionnaires. Qualitative data were subject to thematic analysis, with supplementary quantitative data analysed to generate descriptive statistics. The findings demonstrated a large number of complex and interrelated enabling and impeding factors to the implementation in the case study site. These factors have been grouped into four key themes which have been examined in light of the aims of this study and the issues identified in a comprehensive review of the literature. This study found that: ◦ Conceptual congruence between health promotion and palliative care was a fundamental starting point in the implementation of a health promoting palliative care model. ◦ Where conceptual congruence was clear, activities associated with the model that were regarded as beyond conventional approaches to palliative care core business were viewed favourably by stakeholders and were less likely to encounter resistance within the organisation. ◦ When systematic approaches to organisational change, such as quality improvement systems, were rigorously applied, the impact of the transition upon stakeholders was qualitatively less. ◦ Where this transition had been effectively made, consumers, staff, volunteers and members of the wider community were seen to benefit. This study adds to the current discourse regarding the intersection between end of life support and health promotion, and provides insight into how palliative care organisations might undertake the transition from conventional models to a health promoting palliative care approach.

Text in English / This qualitative psychobiographical study sets out to explore and describe the life of Sir Winston Churchill within the context of his lifelong experience with depression, his ‘Black Dog’. The aim of the research is to present a case for depressive realism with Churchill as the single case study. The reconstruction of Churchill’s life as a psychological narrative is contextualised within the theoretical framework of Alfred Adler’s Theory of Individual Psychology. Data was collated via biographical and life history material. Data was analysed by means of thematic analysis. Data trustworthiness and ethical considerations were adhered to. The findings of this study reveal that Churchill’s depression had positive gains of him striving to contribute to society, potentially demonstrating that depressive realism exists as a side-effect of depression. The significance of which, conceivably substantiates the idea that positive aspects of depression do exist, enabling a potentially more encouraging and constructive outlook for individuals suffering from depression. / Psychology / M.A. (Psychology)

“Why do immigrants and refugees need community health workers/lay health workers (CHWs) if Canada already has a universal health care system?” Abundant evidence demonstrates that despite the universality of our health care system marginalized populations, including immigrants and refugees, experience barriers to accessing the health system. Evidence on the role of CHWs facilitating access is both lacking and urgently needed. This dissertation contributes to this evidence by providing a thick description and thorough analytical exploration of a CHW model, in Edmonton, Canada. Specifically, I examine the activities of the Multicultural Health Brokers Co-operative (MCHB Co-op) and its Multicultural Health Brokers from 1992 to 2011 as well as the relationship they have with Alberta Health Services (AHS) Edmonton Zone Public Health. The research for this study is based on an instrumental and embedded qualitative case study design. The case is the MCHB Co-op, an independently-run multicultural health worker co-operative, which contracts with health and social services providers in Edmonton to offer linguistically- and culturally-appropriate services to marginalized immigrant and refugee women and their families. The two embedded mini-cases are two programs of the MCHB Co-op: Perinatal Outreach and Health for Two, which are the raison d’être for a sustained partnership between the MCHB Co-op and AHS. The phenomenon under study is the Multicultural Health Brokers’ practice. I triangulate multiple methods (research strategies and data sources), including 46 days of participant and direct observation, 44 in-depth interviews (with Multicultural Health Brokers, mentors, women using the programs, health professionals and outsiders who knew of the work of the MCHB Co-op and Multicultural Health Brokers), and document review and analysis of policy documents, yearly reports, training manuals, educational materials as well as quantitative analysis of the Health Brokers’ 3,442 client caseload database. In addition, data include my field notes of both descriptive and analytical reflections taken throughout the onsite research. I also triangulate various theoretical frameworks to explore how historically specific social structures, economic relationships, and ideological assumptions serve to create and reinforce the conditions that give rise to the need for CHWs, and the factors that aid or hinder their ability to facilitate marginalized populations’ access to health and social services. Findings reveal that Multicultural Health Brokers facilitate access to health and social services as well as foster community capacity building in order to address settlement, adaptation, and integration of immigrant and refugee women and their families into Canadian society. Findings also demonstrate that the Multicultural Health Broker model is an example of collaboration between community-based organizations and local systems in targeting health equity for marginalized populations; in particular, in perinatal health and violence against women. A major problem these workers face is they provide important services as part of Canada’s health human resources workforce, but their contributions are often not recognized as such. The triangulation of methods and theory provides empirical and theoretical understanding of the Multicultural Health Brokers’ contribution to immigrant and refugee women and their families’ feminist urban citizenship.

“Why do immigrants and refugees need community health workers/lay health workers (CHWs) if Canada already has a universal health care system?” Abundant evidence demonstrates that despite the universality of our health care system marginalized populations, including immigrants and refugees, experience barriers to accessing the health system. Evidence on the role of CHWs facilitating access is both lacking and urgently needed. This dissertation contributes to this evidence by providing a thick description and thorough analytical exploration of a CHW model, in Edmonton, Canada. Specifically, I examine the activities of the Multicultural Health Brokers Co-operative (MCHB Co-op) and its Multicultural Health Brokers from 1992 to 2011 as well as the relationship they have with Alberta Health Services (AHS) Edmonton Zone Public Health. The research for this study is based on an instrumental and embedded qualitative case study design. The case is the MCHB Co-op, an independently-run multicultural health worker co-operative, which contracts with health and social services providers in Edmonton to offer linguistically- and culturally-appropriate services to marginalized immigrant and refugee women and their families. The two embedded mini-cases are two programs of the MCHB Co-op: Perinatal Outreach and Health for Two, which are the raison d’être for a sustained partnership between the MCHB Co-op and AHS. The phenomenon under study is the Multicultural Health Brokers’ practice. I triangulate multiple methods (research strategies and data sources), including 46 days of participant and direct observation, 44 in-depth interviews (with Multicultural Health Brokers, mentors, women using the programs, health professionals and outsiders who knew of the work of the MCHB Co-op and Multicultural Health Brokers), and document review and analysis of policy documents, yearly reports, training manuals, educational materials as well as quantitative analysis of the Health Brokers’ 3,442 client caseload database. In addition, data include my field notes of both descriptive and analytical reflections taken throughout the onsite research. I also triangulate various theoretical frameworks to explore how historically specific social structures, economic relationships, and ideological assumptions serve to create and reinforce the conditions that give rise to the need for CHWs, and the factors that aid or hinder their ability to facilitate marginalized populations’ access to health and social services. Findings reveal that Multicultural Health Brokers facilitate access to health and social services as well as foster community capacity building in order to address settlement, adaptation, and integration of immigrant and refugee women and their families into Canadian society. Findings also demonstrate that the Multicultural Health Broker model is an example of collaboration between community-based organizations and local systems in targeting health equity for marginalized populations; in particular, in perinatal health and violence against women. A major problem these workers face is they provide important services as part of Canada’s health human resources workforce, but their contributions are often not recognized as such. The triangulation of methods and theory provides empirical and theoretical understanding of the Multicultural Health Brokers’ contribution to immigrant and refugee women and their families’ feminist urban citizenship.