Syfte:Att beskriva föräldrars upplevelse av faktorer om har inverkan på deras närvaro hos sitt extremt underburna barn som vårdats på intensivvårdssal på neonatalavdelning. Material och metod: Semistrukturerade djupintervjuer utifrån en intervjuguide genomfördes under 2010 och 2011. Tretton föräldrar deltog i studien. De inspelade intervjuerna transkiberades ordagrant, och bearbetades med kvalitativ innehållsanalys. Resultat:Föräldrar till extremt underburna barn som vårdais på intensivvårdssal beskrev skilda upplevelser av vården och uttryckte olika behov. Vårdtiden innebar ett känslomässigt pendlande från chock till en känsla av kontroll. Faktorer som underlättade närvaron hos barnet var möjlighet till boende på avdelningen. Att få ökade kunskaper och ta över vården av barnet stärkte föräldrarna i föräldrarollen och ökade motivationen till att vara hos barnet. Genom att känguruvårda barnet kände sig föräldrarna behövda vilket ökade deras närvaro. Försvårande faktorer var miljön på intensivvårdssalen som ibland upplevdes stressfylld med oacceptabelt hög ljudnivå vilket gjorde det svårt att sova och övernatta hos barnet. Personalens arbetssituation hade inverkan på möjlighet till känguruvård eftersom det ledde till väntan på att få hjälp vid förflyttning av barnet från kuvös till förälder. Närvaro vid smärtsamma procedurer upplevdes som försvårande för många av informanterna. / Aim:To describe parents’ experiences of factors that have an impact on their presence with their extremely premature infant who is cared in an intensive care nursery at a neonatal unit. Materials and method:Semi structured interviews based on an interview guide were conducted in 2010 and 2011. Thirteen parents participated in the study. The recorded interviews were transcribed verbatim and processed by qualitative content analysis. Result: Parents of extremely preterm infants, who wore treated in an intensive care nursery, had different experiences of care and expressed different needs. The infant’s hospital stay was an emotional pendulum from chock to a sense of control. A factor that facilitated the parents’ presence with the child was the possibility to live in the neonatal unit. Attainment of more knowledge and taking over their infants’ care empowered the parents in their parental role, which increased their motivation to stay with their infant. Kangaroo Mother Care made parents feel needed which increased their presence. A hindering factor was the environment in the intensive care nursery. This was sometimes experienced as stressful with unacceptable levels of sound which rendered in sleeping difficulties and made it hard for the parents to stay over the night with the infant. Staff working conditions had an impact on their opportunities for Kangaroo Mother Care because this sometimes meant that parents had to wait for assistance with transfer of the infant from incubator to parent. Presence during painful procedures was perceived as an obstacle by several informants.

The trend towards patient-and family-centered care (PFCC) invites families of critically ill patients to participate more fully in the care and recovery of their loved ones through partnerships with the medical team and personalized care that respects the values, beliefs and experiences of the individual. In response to the growing needs of families, healthcare institutions are re-designing the way patient and family care is delivered in terms of policy, culture and the physical environment. Despite the many benefits that come with closer collaboration, nurses report that "challenging" families are a key source of workplace stress. This exploratory case study documents some of these challenges as perceived by staff nurses at Emory University Hospital's Neuro ICU while examining the role the built environment plays in shaping such perceptions. Through a series of ethnographic interviews and observational methodologies, the study identifies some of the challenges and benefits that come with balancing patient and family needs. Nurse strategies developed to reassert spatial and temporal control over work environments are also identified. The second phase of research compares communication patterns generated from two different ICUs to explore the link between unit design and the frequency and quality of nurse-family interactions. Findings suggest that space plays a role in moderating the degree of nurse exposure to the often unstructured and unpredictable aspects of family interactions. These encounters, set within a highly charged critical care setting, may contribute to these perceived challenges. Healthcare stands at an important moment of transition in which attitudes, behaviors and expectations are changing. Together these results reinforce the need for adequate tools, training and education to further support nurses in the transition to this new care culture.

Hjärtinfarkt är en av de vanligaste orsakerna till dödsfall i Sverige. Det är vanligt att de som drabbats har svårt att hantera sin förändrade livssituation eftersom sjukdomen påverkar vardagen fysiskt, psykiskt, socialt och ekonomiskt. Kvinnor har oftare svårare att anpassa sig till livet efter hjärtinfarkten än män. Syftet med studien var att beskriva hur kvinnor upplever det dagliga livet efter en hjärtinfarkt. Metoden för studien var en litteraturöversikt av 10 kvalitativa artiklar. I resultatet framkom fem olika kategorier; En förändrad livssituation som innebär förändrad social roll och hur kvinnan hanterade livet efter hjärtinfarkten. Förändrade relationer beskriver hur relationerna till vänner, familj och arbetskamrater påverkas. Behov av stöd omfattar stödet som kvinnan behöver för att kunna hantera sin nya livssituation. Den förändrade kroppen tar upp vilka kroppsliga symtom som kan komma efter en hjärtinfarkt och Känslomässiga reaktioner beskriver det psykiska måendet som kom med den nya situationen. Slutsatsen är att kvinnorna ofta förlorar kontroll över det dagliga livet och är i behov av stöd både från vårdpersonal och närstående. / Myocardial infarction is one of the most common causes of death in Sweden. It is common for the affected person to have difficulties managing the changes in his or her life situation caused by the disease both physically, mentally, socially and economically. Women have more often difficulties adapting to her life after a myocardial infarction than men do. The aim of this study was to describe how women experience daily life after a myocardial infarction. The methodology for this study was a literature review of ten qualitative studies. The result showed five different categories; A changed life situation, which describes changed social roles and how woman managed life after a myocardial infarction. Changes in relationships, which describes how relationships with friends, family and co-workers are affected. The category Need of support process the assistance that women need in order to manage their new life situation. The changed body, which involves the physical symptoms that can occur after a myocardial infarction and Emotional reactions, which describes the mental condition that accompanies the new situation. The conclusion is that women often lose control over their daily lives and are in need of support from both health care professionals and relatives.

Bakgrund: Det är viktigt att det finns kunskap om palliativ vård inom alla verksamheter då patienter i palliativ vård finns överallt inom vården. Finns inte kunskapen kan patientens behov lätt missas. Författarna till den här studien ville få en förståelse för vilka omvårdnadsbehov sjuksköterskor upplever att patienten har i det palliativa skedet. Syfte: Syftet var att undersöka vilka omvårdnadsbehov sjuksköterskor upplever att patienten har i det palliativa skedet och hur dessa behov kan tillgodoses. Metod: En kvalitativ intervjustudie genomfördes på ett sjukhus. Sju sjuksköterskor intervjuades och intervjumaterialet analyserades med manifest innehållsanalys. Resultat: Resultatet visade att sjuksköterskorna upplevde att patienten i palliativ vård har två övergripande omvårdnadsbehov. Dessa är psykosociala behov och omvårdnadsbehov. I psykosociala behov ingår autonomi, behov av uppmärksamhet, kommunikation och socialt nätverk. I omvårdnadsbehov ingår förutom behovet av omvårdnad även behov av omvårdnadskompetent personal. Konklusion: Studien visade att sjuksköterskorna upplevde att patienten i det palliativa skedet har behov av symptomlindring, samtal, bevarad autonomi, att bli behandlad som en individ, att ha ett stödjande socialt nätverk och kompetent personal.

Bakgrund: Familjer har inte alltid deltagit i omvårdnaden på det sätt de gör idag. Under de senaste decennierna har begreppet familjefokuserad omvårdnad lyfts fram och blivit till en central del inom barnsjukvården. Familjefokuserad omvårdnad lägger tonvikt på familjers deltagande och engagemang i sitt barns vård. Syfte: Syftet är att undersöka hur familjer och sjukvårdspersonal beskriver familjers delaktighet inom barnsjukvården i Norden. Metod: Litteraturstudie av tio vetenskapliga artiklar med kvalitativ design. Resultat: Resultatet presenteras utifrån tre huvudteman. Stöd var en av de viktigaste beståndsdelarna och som också väckte intresse till ökad delaktighet i barnsjukvården. Stöd presenteras i avsnittet familjernas behov av stöd. När ett barn blir sjukt är det inte bara barnets liv som påverkas, utan en hel familjs, vilket presenteras i avsnittet en livsvärld som vänds upp och ner. En svår tid följde de flesta familjer under tiden de försökte vänja sig vid sin nyfunna livssituation. I avsnittet att vårda en hel familj presenteras att varje familj var unik och att de hanterar olika situationer på olika sätt.  Slutsats: Resultatet i denna litteraturstudie har visat på att stöd är en viktig faktor för familjer när ett barn är sjukt. Både stöd från vården och socialt stöd från släkt och vänner är viktigt när det kommer till att stärka familjer samt att få familjen delaktig i barnets omvårdnad. Klinisk betydelse: Denna litteraturstudie kan bidra bredare med kunskap om familjefokuserad omvårdnad samt familjers delaktighet inom barnsjukvården. Calgarymodellen i den familjefokuserade omvårdnaden kan hjälpa sjukvårdspersonal att göra familjer delaktiga genom hela omvårdnadsprocessen. / Background: Families has not always been a part of the pediatric care. Family-centered care is a phenomenon which has been highlighted during the past decades and has become a central part of pediatric care as it is today. Family-centered care includes family participation and family involvement in the child’s care. Aim: To explore how families and nurses define family participation in Nordic Pediatric care.  Method: The aim was answered with a literature review of ten scientific qualitative articles. Results: The result is presented in three head themes. Support was one of the most important elements and contributed to participation in the pediatric care. Support is presented in the theme families’ need for support. When a child becomes ill it’s not only the child’s, but the whole families lifeworld that gets affected, which is presented in another theme, a lifeworld up-side-down. Most families had a hard time adjusting to their new life situation. In the third theme, to care for the whole family, we present that every family is unique and handle situations different.  Conclusion: The result of this literature review has shown that support is an important factor when a child is ill. Good support from health care and social support from family and friends is important to the family members, especially when it comes to family strengthening and to encourage families to participate in the care. Clinical significance: This literature review can contribute knowledge about family-centered care and participation in pediatric care. The Calgary Family Assessment Model can help create good family-centered care and encourage family members to participate in care.

Bakgrund: Missfall är ett ofrivilligt avslutande av en graviditet som kan medföra känslor av chock, sorg och skuld. Vårdtiden vid missfall är ofta kortvarig och vårdpersonal har en betydande roll för kvinnornas upplevelse och återhämtning. Syfte: Syftet var att genom en litteraturstudie beskriva kvinnors upplevelser av missfall och den vård som ges i samband med missfall. Metod: Allmän litteraturstudie baserad på tio vetenskapliga artiklar med en kvalitativ design. Resultat: Resultatet bestod av tre huvudteman med tillhörande subteman. Det första huvudtemat var Kvinnors egna subjektiva tankar och känslor i samband med missfall med subteman Förlust av en graviditet, Skuldkänslor, Oro och förväntningar vid framtida graviditeter. Det andra huvudtemat var Kvinnors erfarenheter av bemötande från vårdpersonal vid missfall, med subteman Attityder och bemötande, Brist på information. Det sista huvudtemat var Kvinnors behov av stöd i samband med missfall med subteman Familj och närståendes betydelse, Vårdpersonalens betydelse. Slutsats: Missfall var en chockartad upplevelse, ofta präglad av existentiell smärta och sorg. Kvinnors erfarenheter av vården var oftast negativa. Kvinnorna hade ett behov av tillräcklig och adekvat information, delaktighet, stöd utifrån den individuella upplevelsen och bekräftelse vilket är faktorer som kännetecknar personcentrerad omvårdnad. Klinisk betydelse: Beskrivning av kvinnors upplevelser av missfall och den vård som ges i samband med missfall kan öka medvetenheten hos vårdgivare om hur kvinnors individuella behov tillgodoses genom personcentrerad omvårdnad. / Background: Miscarriage is an involuntary termination of pregnancy which may cause feelings of shock, sadness and guilt. The hospital stay for miscarriage is often brief and health professionals have an important role in women's experience and recovery. Objective: The objective was to provide a literature review of women's experience of miscarriage and the care associated with miscarriage. Method: Literature review based on ten scientific articles with a qualitative design. Results: The result consisted of three main themes and associated subthemes. The first main theme was Women's own subjective thoughts and feelings associated with miscarriage with subthemes Loss of a pregnancy, feelings of guilt, anxiety and expectations in future pregnancies. The second main theme was Women's experience of how they were treated by healthcare professionals during miscarriage, with subthemes attitudes and treatment, lack of information. The last main theme was Women need of support in association with miscarriage with subthemes significance of family and kindred, professionals importance. Conclusion: Miscarriage was a shocking experience, often marked by existential pain and grief. Women's experiences of care were often negative. The women had a need for sufficient and adequate information, participation, support based on the individual experience and confirmation, which are factors that characterizes person-centered care. Clinical significance: Description of women's experiences of miscarriage and the care associated with miscarriage can increase awareness among health care providers on how women's individual needs are met through person-centered care.

Background: Mental health issues are a growing global problem and there is a big gap between the need for mental health care and the financial resources allocated to this health care sector. Nurses work closely to patients and play an important role in alleviating suffering and in the recovery of the patient. Highlighting the nurses’ role and experiences of working with persons with mental health problems can give information of how to address the different challenges they meet.  Aim: The aim of this study was to describe nurses’ experiences of caring for persons with mental health problems in a psychiatric care setting in the Kurdistan region of Iraq. Method: Seven semi-structured interviews were conducted with a total of eight nurses working at two psychiatric hospitals. Qualitative content analysis was used to analyze the data. Findings: Four main themes were found: Between possibilities and challenges, Holistic view, Striving for equality and Caring relations. Nurses in psychiatric settings in Kurdistan region of Iraq face different challenges related to organization, prejudice and inequality. They have a lot of knowledge about nursing and aim to meet patients and families with a person-centered approach. Conclusion: The findings show that nurses need the work environment to be open to nurses’ thoughts and concerns. Management should involve nurses in the development of the hospital, encourage collaboration and provide on the job training. This would increase the job satisfaction and contribute to a person-centered atmosphere.

Growing up in a family environment that includes child maltreatment can result in an array of negative consequences for children, including health, behavioral, developmental, and social difficulties, and these consequences can persist over the lifetime. Families who have come to the attention of child welfare services for child maltreatment are at particularly high risk for experiencing multiple concurrent problems, including intimate partner violence, substance abuse, and mental health issues, as well as other family challenges. It is essential to intervene effectively with this population. However, there are few qualitative studies of parent experiences in the child welfare system through which to better understand parents' perspectives and identify additional or more effective points of intervention. This exploratory study utilized a mixed-methods design, primarily focusing on in-depth qualitative interviews with parents in the child welfare system, to explore participants' lived experiences within the continuum of child welfare services. Participants in this study experienced a range of interconnected stressors that impacted both their ability to effectively parent their children as well as successfully complete the services required of them by the child welfare system. Qualitative interviews revealed that parents experienced an overall lack of empowerment, effective communication, and support through their experience with the child welfare system, until they accessed the therapeutic services they were required to attend near the end of their time in the system. Parents were more responsive when services were more supportive, rather than punitive, and individualized to their needs and strengths. This study suggests that systematically implementing more individualized, family-centered services throughout the continuum of services provided by the child welfare system would be effective in intervening with families. Findings also indicate the need for continued qualitative research with parents to address both areas of intervention for families who have already maltreated their children and the prevention of maltreatment and other related stressors in families who are at risk.

Addressing the sub-optimal breastfeeding initiation and duration rates has become a national priority. Inadequate support for addressing early breastfeeding challenges is compounded by a lack of collaboration between providers such as lactation professionals, nurses, pediatricians, and the family. The purpose of this exploratory study was to understand International Board Certified Lactation Consultants' (IBCLCs) perceived barriers to managing early breastfeeding problems. This qualitative study was guided by the symbolic interactionist framework through a grounded theory methodological approach. In-depth interviews were conducted with 30 IBCLCs from across Florida. IBCLCs were from a range of practice settings, including hospitals, WIC clinics, private practice, and pediatric offices. Data were digitally recorded, transcribed, and analyzed in Atlas.ti. A range of barriers were identified and grouped into the following categories: indirect barriers such as social norms, knowledge, attitudes; direct occupational barriers such as institutional constraints, lack of coordination, and poor service delivery; and direct individual barriers including social support and mother's self-efficacy. A model was developed to illustrate the factors that influence the role enactment of IBCLCs in terms of managing breastfeeding problems. IBCLCs overwhelmingly wish to be perceived as valued members of a health care team, but often find interprofessional collaboration is a struggle. However, IBCLCs find creative strategies to navigate challenges and describe their role as pivotal in empowering mothers and their families to meet their breastfeeding goals. Though rarely actualized, IBCLCs place strong value on coordinated, team approaches to breastfeeding management that employ transparent communication between providers and focus on empowering and educating mothers. Strategies for better collaboration and communication between IBCLCs and other providers are needed. Findings provide insight into the management issues of early breastfeeding problems and may lead to future interventions to reduce early weaning, thus increasing the lifelong health benefits of breastfeeding to the infant and mother.

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