With the aging of our population and the higher risk of chronic illness and disability with age, more and more family members may be faced with the experience of having a relative transition into a long-term care (LTC) home. This reality necessitates greater understanding of family care partner needs to ensure wellness throughout their caring career. Using participatory action research, notions of wellness were explored for family partners in care with relatives residing in LTC homes. Using two LTC homes from a privately owned company called Specialty Care, ten family members were interviewed, followed by one focus group at each of the two LTC homes. Three major themes were revealed, each with several sub themes: (1) understanding wellness amidst challenges to keep a sense of wellness in life; (2) self-appraisal: becoming aware of personal beliefs and perceptions that influence wellness; and (3) assessing LTC homes and their influence on the experience of wellness. We not only revealed more about wellness and how it is experienced in the caring context, we also discovered leisure’s role in maintaining wellness and how embedded leisure’s influence is on the various aspects of wellness that family partners in care experience. Relationship-centred care is a framework we used to guide this study. It highlights the importance of family member needs, along with the needs of the residents and staff. With our enhanced understanding of family care partner needs, recommendations were made to the Specialty Care communities so they can work together to ensure optimal wellness is maintained for all parties, including family partners in care.

Background During pregnancy, a healthy diet is beneficial for the expecting mother and her fetus. Midwives in antenatal care have an ideal position for promoting a healthy diet and thereby help women to not only lower the risks of pregnancy complications and adverse birth outcomes, but improve maternal health. The overall aim of this thesis was to describe diet and dietary changes during pregnancy from the women’s and the midwives’ perspectives with a focus on dietary counseling. The thesis comprises four studies. The specific aims in the respective studies were to: I) Describe pregnant women’s attitudes to and experiences of dietary information and advice, as well as dietary management during pregnancy. II) Explore midwives’ strategies in challenging dietary counseling situations. III) Describe how midwives’ perceive their role and their significance in dietary counseling of pregnant women.  IV) Describe women’s food habits during pregnancy and up to six months postpartum. Methods Studies I-III were qualitative. Study I included focus group interviews with 23 pregnant women. Study II included telephone interviews with 17 experienced midwives working in Swedish antenatal health care. Study III included the same 17 interviews from study II and supplemented them with four face-to-face-interviews. Qualitative content analysis was performed in all three studies. Study IV was a longitudinal study including a quantitative analysis of a questionnaire, which was given to women at five occasions during and after pregnancy. It concerned their food habits and it was answered by 163 women. The quantitative data was analyzed using comparative and descriptive statistics. Results The overall findings of the thesis were summarized as the main theme “Pregnant women and midwives are not in tune with each other about dietary counseling”. The main theme included the two themes ‘Pregnant women are concerned about risks for their child but fail to change to healthier dietary habits over time’, and ‘Midwives view themselves as authorities, though questioned ones’. In subthemes it was highlighted that pregnant women are well informed and interested in risk reduction for their child’s best and that they try to do their best to improve their diet during pregnancy. However, their diet did not reach levels of healthy eating recommendations and became even unhealthier after pregnancy. It was also highlighted that midwives experienced insufficient knowledge in dietary issues and related risks and that they had difficulties to give dietary support to pregnant women. Midwives were found to mainly focus on giving information and they lacked sufficient competence for challenging counseling. Conclusion Pregnant women, on the one hand, experience a lack of support from the midwives when dealing with dietary changes. The midwives, on the other hand, feel exposed and express a need for both further education in dietary issues and training in counseling. Women’s food habits during, but in particular after pregnancy need improvement, and dietary counseling could be more focused on healthy eating in a long-term perspective. / <p>Felaktigt ISSN angivet i avhandlingen och på spikbladet.</p>

Šio darbo tikslas – įvertinti pacientų, patyrusių nugaros smegenų pažeidimą, savarankiško veiklos vertinimo reikšmę ergoterapijos taikymui ankstyvuoju reabilitacijos laikotarpiu. Tyrimo uždaviniai: įvertinti pacientų, patyrusių nugaros smegenų pažeidimą, funkcinę būklę ir veiklos sutrikimus, taikant tradicinius vertinimo metodus; įvertinti pacientų, patyrusių nugaros smegenų pažeidimą, veiklos sutrikimus, taikant savarankiško veiklos vertinimo metodus; bei nustatyti tradicinio ir savarankiško veiklos vertinimo metodų ryšį, vertinant pacientų, patyrusių nugaros smegenų pažeidimą, veiklos sutrikimus, priklausomai nuo pažeidimo pobūdžio bei amžiaus. Tyrimas buvo atliktas VšĮ VUL Santariškių klinikų, Reabilitacijos, Fizinės ir Sporto Medicinos Centro I – ame ir II – ame stacionariniuose skyriuose 2007 02 – 2008 04 mėn. Tyrime dalyvavo 29 pacientai, patyrę nugaros smegenų pažeidimą. Iš jų, 25 (86,2%) buvo vyrai ir 4 (13,8%) moterys, amžiaus vidurkis 35,03 (SD ± 14,2) metai. 16 (55,2%) pacientų atvyko su kaklinės nugaros smegenų dalies pažeidimu, 11 (37,9%) pacientų buvo pažeista krūtininė nugaros smegenų dalis, 2 (6,9%) pacientai atvyko su juosmeninės nugaros smegenų dalies pažeidimu. 13 (81,3%) pacientų, patyrusių kaklinės nugaros smegenų dalies pažeidimą, 5 (45,5%) pacientų, patyrusių krūtininės nugaros smegenų dalies pažeidimą, buvo nustatytas ASIA – A tipo pažeidimo laipsnis, juosmeninės nugaros smegenų dalies pažeidimą atyrusiems pacientams buvo nustatytas buvo ASIA –... [toliau žr. visą tekstą] / The aim of this study – to evaluate influence of self assessment for occupational therapy in early rehabilitation period, of patients with spinal cord injury. Goals of this study: to evaluate functional outcomes and occupational performance issues, using traditional assessment methods; to evaluate occupational performance issues, of patients with spinal cord injury, using client – centred methods; to determine the relation between traditional and client – centred assessment methods, dependantly on spinal cord injury level and patients` age. The research took place at a Vilnius University hospital Santariškių klinikos, Centre of Rehabilitation, Physical and Sports Medicine inpatient departmens in 2007 02 – 2008 04. The research contingent consisted of 29 patients with spinal cord injury: 25 (86,2%) were men and 4 (13,8%) women, average of age 35,03 (SD ± 14,2) years. According to the level of spinal cord injury, 16 (55,2%) patients suffered from cervical spinal cord injury, 11 (37,9%) patients suffered from thoracic spinal cord injury and 2 (6,9%) patients had lumbar spinal cord injury. For 13 (81,3%) patients with cervical spinal cord injury was identified complete (American Spinal Injury Association (ASIA-A)) injury, for 5 (45,5%) patients with thoracic spinal cord injury was identified complete (ASIA – A) injury and both patients with lumbar spinal cord injury were identified to have incomplete (ASIA – C) injury. The data were obtained from medical history records and... [to full text]

This qualitative study explored and described the lived experience of people with brain injuries with regard to resuming their worker roles. Based on the results, an occupational therapy practice model to facilitate return to work was developed. The theoretical framework of occupational science with emphasis on occupational risk factors informed the study. The research design was a theory generative design based on a qualitative, phenomenological, explorative and descriptive research approach utilizing the methods of theory generation as advocated by Chinn and Kramer (1999), Walker and Avant (2005) and Dickoff, James and Wiedenbach (1968).

The study looks at Lesotho Science teachers' understanding, practice and explanation of learner-centred education (LCE) prior to, during and after different activities. Six Physics teachers from Maseru were selected from 20 who attended an initial meeting and workshop. The selected teachers participated in the research for two years, completing a Baseline Study, then 3 cycles of planning, acting, observing, and reflecting in the action research on LCE. During the Baseline Study and each of the action research cycles, the teachers' explanations, understandings and practices of learner-centred education were determined through analyses of discussions and meetings, lesson plans, classroom practices, responses to the literature and other support activities, and interviews with the teachers. The process was collaborative, with the teachers and the researcher working as a team in the planning, observations of classrooms, reflections and analyses. The teachers changed their understanding and practices significantly in the course of the study. Consistent with the Concerns-based Adoption Model (CBAM), their primary concerns shifted from classroom management issues and impediments to learner-centred education in their schools at the start, to adaptation, innovation, and conducting teacher-workshops at the end. Early in the project, they opted for a model of learner-centred education comprised of three levels: caring for learners and their learning; adopting learner-centred teaching methods and allowing learners to influence the content and desired outcomes of the learning. During the research, within the team and in classrooms, the teachers developed each of these levels, though they applied the third level more in their own learning as part of the action research, than in their classrooms. At the end, the teachers co-constructed a model of LCE which they felt was doable under the conditions in Lesotho (including school constraints and competing demands on teachers and curriculum), and which would meet the expectations of principals, parents and learners. The teachers changed not only in their professional knowledge and skills, but in social-professional and self-professional aspects. For example, they began inviting other teachers to observe their classes, they conducted workshops in their schools, and enrolled for higher degrees. The teachers persisted with the study for two years, not because of school expectations or pressures, but because they wanted to participate. Their motivation was high, arising from a mix of personal, professional, career and school factors. Their motivations shifted during the research, as their knowledge and concerns changed, and they came to see different opportunities from what they had imagined at the start. Through participation and collaboration, they extended the objectives and outcomes of the study beyond its initial focus on learner-centred education in classrooms: they defined and addressed their own personal, social and professional interests. The data demonstrated that teachers' engagement with in-service activities that provide for long-term project-based learning, critical collaboration, support and reflection, can bring personal and group change more significantly than in conventional district and national workshops. / Theses (Ph.D.)-University of KwaZulu Natal, 2005.

Bakgrund: Diabetes är en kronisk metabol sjukdom och det finns två sorter. Typ 1 kallas den som orsakas av bristande insulinproduktion. Nordiska riktlinjerna för barn och ungdomar rekommenderar 60 minuter fysisk aktivitet per dag.   Syfte: Syftet med denna litteraturstudie var att belysa vikten av fysisk aktivitet hos barn och ungdomar med typ 1 diabetes samt vilka faktorer som påverkar deras fysiska aktivitet.   Metod: En litteraturstudie innehållande 16 vetenskapliga artiklar som erhållits genom databaserna PubMed och Cinahl. Dessa har granskats, kvalitetsbestämts och sammanfattats. Resultatet har därefter analyserats och presenterats under två huvudteman med tillhörande subteman.   Resultat: Efter granskning av de involverade artiklarna framkommer det att den fysiska aktiviteten är viktig för barn och ungdomar med typ 1 diabetes. Det är viktigt för att de ska ligga på en bra glukosnivå, men även för att motverka exempelvis framtida sjukdomar och övervikt. De hinder som de kan drabbas av är bland annat hypoglykemi men även val av metod för tillförsel av insulin, som kan begränsa dem i vilken form av fysisk aktivitet de kan utföra.   Slutsats: Den fysiska aktiviteten är viktig för barn och ungdomar med typ 1 diabetes och bör ses som en behandlingsmetod. Vården bör vara personcentrerad för att kunna mota de hinder som kan uppstå och för att nå fram till barnen och ungdomarna. / Background: Diabetes is a chronic metabolic disease and there are two types. Diabetes type 1 is known as the one caused by lack of insulin production. A Nordic guideline for children and adolescents recommends 60 minutes of physical activity per day.   Objective: The aim of this study was to highlight the importance of physical activity in children and adolescents with diabetes type 1 and their potential barriers to physical activities.   Method:  In total 16 scientific articles were included after searches in the databases PubMed and Cinahl. The articles were quality audited, summarised and analysed. In total two themes and four subthemes were obtained.   Results: After analysed the involved articles it reveals that the physical activity is necessary for the children and adolescents with diabetes type 1. It’s necessary for keeping the glucose level stabile, but also to prevent future diseases and obesity.  The obstacles that they can suffer are for instance hypoglycaemia, but also the choice of method to take insulin can limit them in what physical activity that they can perform.   Conclusion: Physical activity is important for children and adolescents with diabetes type 1, and should been seen as a treatment method. The healthcare should be person-centred to be able to face the obstacles that may arise and to reach the children and adolescents.

The purpose of this study was to research the therapeutic outcomes achieved by a five year-old boy with Asperger Syndrome (AS), by means of non-directive processes of child centred play therapy (CCP) and sand tray play therapy (STP). In this investigative-descriptive qualitative research design, a saturated, holistic, intrinsic single case study was used as research method. The therapeutic process, events and outcomes of a unique single case within the context of AS, non-directive play therapy and the interactional-pattern analysis (IPA), are described. This study was motivated by the fact that the researcher disposed of data for a unique single case study that could contribute meaningfully to the need for a research database that describes effective therapeutic interventions and outcomes with children with AS. From the perspective of Rogerian person-centred theory (RPT), the literature study focused on an integrated discussion of AS, CCP and STP by means of 17 interpersonal variables of the interactional-pattern analysis (IPA). The following data sources was investigated: interviews with parents and teachers; CCP-sessions of J recorded on video; photos of some of J’s STP-sessions and the therapists’ process notes. Triangulation was used to evaluate the various categories of therapeutic outcomes from different viewpoints and to give meaning to them. The conclusions indicated that this boy with AS had used the non-directive processes of CCP and STP to achieve various therapeutic outcomes in the areas of: imaginary play; dramatic play; social interaction with the therapist, parents, family, teachers, his peer group and with strangers; traumatic experiences during visits to the doctor and bath times; identification, expressing and regulating emotions; and minimising acting out behaviour. Therapeutic outcomes have been demonstrated in 8 IPA-variables, namely: empathy, defining of relationships, potential to evoke acceptance or rejection, sincere interest and congruent conduct, control, emotional distance, problem solving and aspects relating to the presenting problem. The conclusion was reached that the conduct of the boy with AS as well as his mother and the therapist, played a mutual role in achieving his therapeutic outcomes within the 17 IPA-variables. The unstructured process of the non-directive play (CCP and STP) was utilised by a young child with AS to achieve therapeutic outcomes that relate to his everyday existence. A final conclusion is that involving the boy’s mother in his therapy and utilising an adapted Filial play program, enabled the mother to make emotional contact with her son and to diminish conflict between them. Guidelines for therapists are suggested with regard to non-directive responding in therapeutic contexts as found in this study. Furthermore, the contribution of this research to Psychology as science and discipline, is presented. Limitations of this study are indicated and recommendations for further research are made. / Thesis (Ph.D. (Psigologie))--North-West University, Vaal Triangle Campus, 2013

Background Type 2 diabetes demands self-management over time, to maintain health and reduce the risk for diabetes complications. However, despite efforts, many persons with type 2 diabetes are not reaching the treatment targets. In diabetes, person-centred care and group education are recommended. Diabetes specialist nurses (DSNs) working in primary healthcare have an important role in supporting patients with type 2 diabetes in their self-management to adapt to the demands of the disease in everyday life. Therefore, it is important to explore the DSNs’ professional role and their experiences of practising person-centred care. The overall aim of the thesis was to explore the professional role of DSNs in primary healthcare, and to describe their experiences of person-centred diabetes care. Methods The thesis includes three studies with qualitative, and one with a quantitative, approach. Data collection consisted of focus group interviews, individual interviews, observations, and questionnaires. Qualitative content analysis and statistics were used in the analysis. In studies I and II, 29 and 31 DSNs participated, respectively. In study III, 10 DSNs and 44 persons with type 2 diabetes participated. Lastly, in study IV, 10 DSNs participated. Results The results in the thesis showed that DSNs have a complex and multifaceted professional role that entails striving to be an expert, a fosterer, a leader, an executive, and a role model, which they found challenging. The DSNs perceived high job demands, such as decision-making and learning. The thesis also showed that the interaction between DSNs and persons with type 2 diabetes shifted from empowerment to authority struggles during group support sessions based on person-centred care. The experience of person-centred care was described as enriching, but DSNs also expressed ambivalence, related to an altered professional role. Conclusion There is a desire by DSNs to be close to persons with type 2 diabetes, although they have several challenges to fulfil, which makes it difficult to uphold a relation with proximity; thus, distance is also present. Even though person-centred care is recommended in healthcare, and despite DSNs’ efforts to practise PCC, the result of this thesis shows that it also implies an altered professional role for DSNs that has to be addressed. / Diabetes intervention in Västerbotten, DIVA 2

With the aging of our population and the higher risk of chronic illness and disability with age, more and more family members may be faced with the experience of having a relative transition into a long-term care (LTC) home. This reality necessitates greater understanding of family care partner needs to ensure wellness throughout their caring career. Using participatory action research, notions of wellness were explored for family partners in care with relatives residing in LTC homes. Using two LTC homes from a privately owned company called Specialty Care, ten family members were interviewed, followed by one focus group at each of the two LTC homes. Three major themes were revealed, each with several sub themes: (1) understanding wellness amidst challenges to keep a sense of wellness in life; (2) self-appraisal: becoming aware of personal beliefs and perceptions that influence wellness; and (3) assessing LTC homes and their influence on the experience of wellness. We not only revealed more about wellness and how it is experienced in the caring context, we also discovered leisure’s role in maintaining wellness and how embedded leisure’s influence is on the various aspects of wellness that family partners in care experience. Relationship-centred care is a framework we used to guide this study. It highlights the importance of family member needs, along with the needs of the residents and staff. With our enhanced understanding of family care partner needs, recommendations were made to the Specialty Care communities so they can work together to ensure optimal wellness is maintained for all parties, including family partners in care.

Bakgrund: Vi har idag en stor del inläggningar av patienter på sjukhus som lider av någon form av demenssjukdom. Omvårdnaden av kroppsligt sjuka patienter som har en demensdiagnos är komplex eftersom dessa har speciella behov relaterat till sina kognitiva, funktionella och beteendemässiga förändringar. Denna komplexa vård kan bli svårhanterlig för omvårdnadspersonalen i sjukhusmiljö vilket kan leda till att omvårdnaden blir lidande Syfte: Syftet med litteraturstudien var att beskriva omvårdnadspersonalens syn på och upplevelser av att vårda patienter med demenssjukdomar som är inlagda på sjukhus. Metod: En allmän litteraturstudie gjordes på ett systematiskt sätt, resultatet baserades på åtta kvalitativa originalartiklar Resultat: Resultatet utgår från tre olika huvudkategorier: Omvårdnadspersonalens upplevelse av och syn på sin egen roll i vården av patienter med demenssjukdom, omvårdnadspersonalens upplevelse av och syn på patienter med demenssjukdom och deras behov samt omvårdnadspersonalens upplevelse av och syn på ledningen, organisationen och miljön i relation till patienter med demenssjukdom. Slutsats: Värdigheten och integriteten av personer med demenssjukdom försvinner på sjukhusavdelningarna på grund av att den personcentrerade vården minskar då omvårdnadspersonalen har en stereotyp bild av personer med demenssjukdom, eftersom det finns tidsbrist på avdelningarna, att miljön på avdelningarna inte är optimal för denna patientkategori samt att sjukhusledningarna tar fel beslut och inte har tillräcklig förståelse för situationen på avdelningarna. / Background: We currently have a large proportion of admissions in hospital suffering from some form of dementia. Nursing care of physically ill patients who have a dementia diagnosis is complex because people with dementia have specific needs related to their cognitive, functional and behavioural changes. This complex care can be cumbersome for nursing staff in the hospital setting, this may contribute to that the care may suffer Aim: The aim of this literature review was to describe nursing staffs´ views on and experiences of experiences of caring for patients with dementia who are admitted to hospital. Method: A literature review was done in a systematic way, the result was based on eight quality original articles Results: The results are based on three main categories: Nursing Staff's experiences of and view on their own role in the care of patients with dementia, nursing staff's experiences of and views on patients with dementia and their needs as well as nursing staff experiences of and view on management, organization and the environment in relation to patients with dementia. Conclusion: Dignity and integrity of persons with dementia disappear in hospital departments due to that the person-centred care decreases when nursing staff have a stereotypical image of people with dementia, as there are time constraints on the wards, that the environment of the department is not optimal for this type of patients and that hospitals' management taking wrong decisions and do not have sufficient understanding of the situation on the wards.