Objectives: To explore why so few mothers breastfeed when their babies are admitted to neonatal intensive care unit (NICU), and to gain an understanding of the impact of this for the mothers and staff involved. DESIGN: This study adopted an ethnographic approach. The data collection involved 135 hours of participant observation over a 6-month period and 32 semi-structured interviews of 17 mothers, 10 nurses, and 5 physicians. Findings: Data from the participants’ interviews and the participant observation were analysed focusing on the two different perspectives; one relating to the mothers and the other to the staff members and their working conditions. The mothers’ experiences were revealed as a developing process as their feeling changed from fearful and terrifying toward becoming and feeling like a ‘real’ mother. Their experience of mothering and breastfeeding differed from their expectations in that breastfeeding became a complex process for some and impossible for others. Five distinct themes emerged; the first highlighted the crisis, which involved the mother's feelings of emotional instability, their strategies for coping such as not visiting the baby, and recognition of the NICU as a stressful environment. The second theme described issues relating to control and power. This involved the perception of having a lack of control and needing to seek permission, the use of language as a mechanism for control, and mothers being placed in a subordinate role. The third theme related to the separation, which included difficulties of acceptance, feeling like stranger and not being important, and the need for physical closeness. Acceptance and adaptation comprised the fourth theme in which gradual acceptance occurred and a spiritual aspect emerged. The final theme, becoming a mother, included issues such as the special moments, breastfeeding as a turning point, and practical and informational needs. Almost all the mothers in this study spoke about going through all these stages during their infants’ stay in the NICU. Analysis of these findings suggests that mothers who deliver prematurely, may have their rite of passage into motherhood interrupted, resulting in them being placed in a position of suspended liminality. v The data also suggest that while staff members agree with the benefits of breastfeeding for preterm infants, the actual implementation of a breastfeeding policy within the neonatal units is more problematic. Three key themes emerged from the analysis relating to the staff perspectives. The first described the contradiction that exists between the staff beliefs and behaviours in relation to breastfeeding and supporting mothers. Elements that comprised this theme were “breast milk is best”, perceiving breastfeeding promotion as a nicety not a necessity; lacking support for mothers, and abdication of responsibility. The second theme related to their working conditions: this included a lack of institutional support for the health care team, and barriers to support breastfeeding. The final theme of controlling relationships captured the essence of the practitioner: mother association. Together, these elements revealed a situation whereby staff appeared more preoccupied in addressing the task aspect of care for the babies than supporting mothers in feeding and subsequently mothering their preterm child. Conclusions: An understanding of the experiences of mothers of preterm infants who wish to breastfeed, and the connection that breastfeeding has to the process of becoming a mother, allows for the finding of more positive strategies to support mothers and breastfeeding within the NICU. This study reveals a new understanding of how breastfeeding is connected to the process of becoming a mother, within the context of two Jordanian NICUs. It also highlights the difficult working conditions for nurses within these units. It is anticipated that recognition of these findings may assist with service developments and lead to improvements in the NICU environment in Jordan, thus enhancing health care delivery in accordance with the individual needs of infants and their mothers.

Titel: Erfarenheter av stigmatisering i hälso- och sjukvården bland personer som drabbats av HIV - En litteraturstudie. Bakgrund: HIV (Humant Immunbrist Virus) har länge varit förknippat med stigmatisering eftersom okunskap och osäkerhet fortfarande förekommer beträffande smittvägar och smittbarhet.                                                                                                           Syfte: Syftet med studien var att belysa erfarenheter av stigmatisering i hälso- och sjukvården bland personer som drabbats av HIV. Metod: En litteraturstudie genomfördes med tio stycken kvalitativa artiklar från åtta olika länder. Artiklarna granskades, analyserades och sammanställdes.                                                                                                               Resultat: I resultatet presenteras två kategorier och fem underkategorier. Kategorierna är: Att bli bemött med bristande vård handlingar och upplevelser av integritetskränkning. Underkategorierna är: Överdrivna säkerhetsåtgärder, ignorant bemötande, bristande sekretess, kränkande kroppsspråk och kränkande verbal kommunikation. Konklusion: Bristande kunskap om HIV kan internationellt ses som en bidragande faktor till att patienter än idag upplever varierande stigmatiserade bemötande från vårdpersonal. För att motverka stigmatiseringen krävs forskning som kan generera kunskap om hur vårdpersonal kan ge ett bättre bemötande och att denna kunskap sprids till vårdpersonal. Nyckelord: HIV, stigmatisering, patientupplevelse, diskriminering. / Title: Experiences of stigma in health care among people affected by HIV- A literature review Background: HIV (Human Immunodeficiency Virus) has been associated with stigmatization for a long time because of ignorance and uncertainty still exists regarding the transmission routes and infectivity. Aim: The aim for the study was to highlight experiences of stigma in health care among people affected by HIV. Method: A literature study was conducted with ten qualitative articles from eight different countries. The articles were examined, analyzed and compiled. Results: The result generated two categories and five subcategories. The categories are: To be treated with a lack of care actions and experiences of integrity violation. The sub-categories are: excessive security measures, ignorant attitudes, lack of secrecy, offensive body language and abusive verbal communication.                                                                   Conclusion: Lack of knowledge about HIV can be seen internationally seen as a contributing factor to the patients still experiencing varying stigmatized treatment by health professionals. To counteract the stigma requires research that can generate knowledge on how health professionals can provide better treatment and that this information is disseminated to the medical staff. Keywords: HIV, stigmatization, patient-experience, discrimination.

Bakgrund: I Sverige är barnhälsovården frivillig, att få ett hembesök när barnet är nyfött är ett erbjudande. Sedan år 2015 erbjuds föräldrar ytterligare ett hembesök när barnet är åtta månader. För att ge bra stöd till föräldrarna i deras egenvårdande roll är det viktigt att veta hur föräldrarna upplever hembesök från barnavårdcentralen (BVC). Syfte: Att undersöka föräldrars upplevelse och erfarenhet av hembesök från BVC. Metod: Data samlades in genom att lägga ut frågor på 2 föräldraforum under 3 månader och söka inlägg på 11 föräldraforum som svarade på studiens frågeställningar och som var skrivna år 2013 - 2016. Data analyserades med induktiv innehållsanalys. Resultat: Föräldrar hade varierade upplevelser av hembesök från BVC, från bekvämlighet, exempelvis upplevdes det som positivt att slippa ge sig ut i dåligt väder, till en känsla av att bli kontrollerad som förälder.  Många föräldrar kände inte till att BVC erbjuder 8-månaders hembesök, och en del kände inte till att BVC erbjöd hembesök överhuvudtaget. Flera föräldrar uttryckte en osäkerhet runt syftet med hembesök. Slutsats: Det är viktigt att distriktssköterskan har en bra rutin för hur, var och när informationen om hembesök skall ges för att informationen om hembesök skall nå fram till alla föräldrar. Informationen kan ha en stor betydelse för hur föräldrar kommer att uppleva hembesöket från BVC och om föräldrar tackar ja till hembesök. / Background: In Sweden, child healthcare is voluntary and home visit by a nurse when the baby is newborn is an offer. Since 2015, parents are offered a second home visit when the baby is eight months. To provide good support to the parents in their caring role it is important to know how the parents experience the home visits by the child health center (CHC). Objective: To investigate the parents' experience of home visits from CHC. Method: Data was collected by posting questions in two parent forums during 3 months and searching for posts in 11 parent forums from 2013 to 2016. Data was analyzed by inductive content analysis. Results: The parents had varying experiences of home visits; from comfort, for example was perceived as positive to avoid having to go out in bad weather, to a sense of being controlled as a parent. Many parents were unaware that the CHC offers a home visit at eight months, and some were unaware that home visits were offered at all. Several parents expressed an uncertainty about the purpose of the home visit. Conclusion: It is important that the district nurse has a good routine of how, where and when information about home visits is given to reach all parents. The information can have a significant impact on how parents will experience home visit from the CHC, and if they will accept home visits.

The main objective of this study was to study individuals experience of panic disorder. The underlying method in the study was of qualitative art, were theme based analysis were used and semi structured interviews were conducted. Six interviews were conducted with individuals that for themselves or with the help of primary care for filled the DSM-IV criteria for panic disorder. The results showed that the participants felt that their panic disorder was more or less prominent depended on the stability of the participants subsistence. The participants felt less of their panic disorder if they had a more stable subsistence and felt the panic-disorder were more prominent if the participants felt more stressed. The interviews led to four themes, The Individuals experience of panic disorder, life situation, sense of losing control and a sense of no one would understand. / Syftet med studien är att undersöka individers upplevelse av panikångest. Studien är kvalitativ och bygger på tematisk innehållsanalys, för studien har sex semistrukturerade intervjuer genomförts med individer som enligt sig själv eller sjukvården uppfyller DSM-IV kriterier för panikångest. Resultatet presenterar den enskilde individens upplevelse av panikångest. Resultatet visar att intervjupersonerna upplevde sin panikångest som mer eller mindre framträdande beroende av stabiliteten i deras tillvaro. En stabil tillvaro upplevdes av deltagara minska panikångesten och en mer stressad tillvaro, upplevdes av deltagarna att öka deras panikångest. Intervjuerna ledde fram till fyra teman, Individens upplevelse av panikångest, livssituation, känsla av total kontrollförlust samt känsla av att ingen skulle förstå.

Customer churn is always a grievous issue for the Telecom industry as customers do not hesitate to leave if they don’t find what they are looking for. They certainly want competitive pricing, value for money and above all, high quality service. Customer churning is directly related to customer satisfaction. It’s a known fact that the cost of customer acquisition is far greater than cost of customer retention, that makes retention a crucial business prototype. There is no standard model which addresses the churning issues of global telecom service providers accurately. BigData analytics with Machine Learning were found to be an efficient way for identifying churn. This thesis aims to predict customer churn using Big Data analytics, namely a J48 decision tree on a Java based benchmark tool, WEKA. Three different datasets from various sources were considered; first includes Telecom operator’s six month aggregate active and churned users’ data usage volumes, second includes globally surveyed data and third dataset comprises of individual weekly data usage analysis of 22 android customers along with their average quality, annoyance and churn scores by accompanying theses. Statistical analyses and J48 Decision trees were drawn for three different datasets. From the statistics of normalized volumes, autocorrelations were small owing to reliable confidence intervals, but confidence intervals were overlapping and close by, therefore no much significance could be noticed, henceforth no strong trends could be observed. From decision tree analytics, decision trees with 52%, 70% and 95% accuracies were achieved for three different data sources respectively.      Data preprocessing, data normalization and feature selection have shown to be prominently influential. Monthly data volumes have not shown much decision power. Average Quality, Churn Risk and to some extent, Annoyance scores may point out a probable churner. Weekly data volumes with customer’s recent history and necessary attributes like age, gender, tenure, bill, contract, data plan, etc., are pivotal for churn prediction.

Bakgrund: Att drabbas av stroke i unga år innebär en stor livsförändring. Försämrad livskvalitét, nedsatt välbefinnande och påverkade relationer är några konsekvenser av att insjukna. Många får dessutom bestående funktionsnedsättningar som påverkar vardagen, såväl i hemmet som på arbetet. En stroke innebär ett trauma som är svårt att hantera för de drabbade individerna, sjukdomen ses som något som bara drabbar äldre. Tidigare studier visar att professionellt stöd till unga individer som drabbas av stroke är begränsat. Syfte: Syftet med studien var att beskriva unga kvinnors upplevelser av livet efter att ha drabbats av stroke. Metod: Analysmetoden som användes var en kvalitativ innebördsanalys av narrativa texter från sex bloggar, skrivna på svenska av kvinnor i åldrarna 26-45 år, bosatta i Sverige. Resultat: Unga kvinnor som drabbats av stroke upplevde att livet efter insjuknandet bestod av ett ständigt sökande efter mening och sammanhang. De fick genomleva mycket oförståelse och kände skuld och skam över att inte längre passa in. Kvinnorna upplevde brist på professionellt stöd och fick därmed stödja sig på sina anhöriga. Slutsats: Unga kvinnor som drabbats av stroke är i behov av stöd och rehabilitering. Omvårdnaden behöver bli mer person- och familjecentrerad för att minska lidande hos kvinnor som lever med konsekvenserna av stroke. / Background: Suffering a stroke at a young age is life-changing. Reduced quality of life and well-being, and impact on relationships are some of the consequences following the disease. Some people get permanent disabilities that affects everyday life, both at home and at work. A stroke often means a trauma that is hard to handle for the individuals, and the disease is seen as something that only affects older people. Previous studies show that professional support to young individuals suffering a stroke is limited. Aim: The aim of this study was to describe young women's experiences of life after having suffered a stroke. Method: This study was made with a qualitative meaning analysis of narrative texts from six blogs, written in Swedish by women, age 26-45, living in Sweden. Results: Young women experienced life following a stroke as a constant search for meaning and coherence. They had lived through a lot of misunderstandings and they felt guilty and ashamed because they no longer fit in. The women experienced lack of professional support and therefore had to rely on their relatives for support. Conclusion: Young women who have suffered a stroke are in need of support and rehabilitation. Nursing care needs to be more person- and family centered to minimize suffering in women living with the consequences of stroke.

Introduktion: Attention Deficit Hyperactivity Disorder (ADHD) definieras som en neuropsykiatrisk funktionsnedsättning vilket innebär betydande svårigheter med att få en fungerande vardag. Huvudsymtomen yttrar sig ofta som uppmärksamhetsproblem, bristande impulskontroll samt hyperaktivitet. De flesta blir diagnostiserade i tidiga barnaår, problemen är ofta kvarstående i vuxen ålder och forskning tyder på viss ärftlighet. Syfte: Att beskriva hur vuxna personer med diagnosen ADHD hanterar och upplever sitt dagliga liv med fokus på familje- och arbetsliv samt att redogöra för vilken datainsamlingsmetod som använts i valda artiklar. Metod: Litteraturstudien genomfördes med deskriptiv design, bestående av elva vetenskapliga artiklar. Artiklarna är hämtade från Högskolan i Gävle biblioteks databaser: Scopus, PsycINFO, Cinahl samt PubMed. Fem centrala kategorier hittades när de inkluderade artiklarna granskades och sammanställdes i litteraturstudiens resultat. Resultat: Det framkom att individer med ADHD upplever att symtomen försvårar familje- och arbetssituationen, men kan bidra till en ökad kreativitet. För att hantera symtomen byter individerna arbeten och/eller partners ofta. Föreskrivna läkemedel uppges bidra till ökad fokusering. Självmedicinering med illegala droger är vanligt för att dämpa symtomen. Datainsamlingsmetoderna i de inkluderade artiklarna bestod i majoritet av semistrukturerade intervjuer. Slutsats: Resultatet påvisade att individer med ADHD genomgående upplevde liknande symtom, dessa upplevdes som negativa då de påverkade det dagliga livet med svårigheter att få fungerande relationer i arbets- och familjelivet. Ökad kunskap inom området är av stor betydelse då sjuksköterskan kan bidra till att patienten kan hitta en jämnvikt i sin livssituation. Kunskapsluckan inom området är stort och behovet av fortsatt forskning är betydande. / Introduction: Attention Deficit Hyperactivity Disorder (ADHD) is defined as a neuropsychiatric disability which means significant difficulty in getting a functional day. The main symptoms often manifest themselves as attention problems, poor impulse control and hyperactivity. Most will be diagnosed in early childhood, the problems are often persisting into adulthood and research suggests certain heredity. Aim: To describe how adults with ADHD manage and experience their daily life with a focus on family and work and to report on the data collection method used in the selected articles. Method: Literature study was conducted with descriptive design, consisting of eleven scientific articles. The articles are from the University of Gävle library databases: Scopus, PsycINFO, CINAHL and PubMed. Five central categories were found when the included articles were reviewed and collected literature results of the study. Results: It was found that individuals with ADHD experience the symptoms complicate family and work situations, but can contribute to increased creativity. To manage the symptoms, the individuals switched work and/or partners often. Prescribed drugs reported to contribute to increased focus. Self-medication with illegal drugs are common to suppress the symptoms. Data collection methods included in the articles comprised in the majority of semi-structured interviews. Conclusion: The results showed that individuals with ADHD consistently experienced similar symptoms, those perceived as negative as they affected the everyday life with difficulty in functioning relationships in family and working life. Increased knowledge in this area is of great importance when the nurse can help the patient to find an equilibrium in their lives. The knowledge gap in the field is great and the need for further research are significant.

Bakgrund: Begreppet palliativ vård definieras som ett förhållningssätt där det centrala målet är att förbättra patienters och anhörigas livskvalitet. Behovet av palliativ vård är stort då allt fler blir äldre. Sjuksköterskor kan möta patienter i palliativa skeden inom olika vårdsammanhang och upplever att kunskapen är otillräcklig. Syfte: Syftet var att beskriva patienters upplevelser av att leva med sjukdom i ett palliativt skede, samt att beskriva de valda artiklars undersökningsgrupper.  Metod: Litteraturstudie med en beskrivande design innefattande 13 artiklar med kvalitativ ansats från databaserna CINAHL och MEDLINE via PubMed.  Huvudresultat: Att leva i ett palliativt skede upplevdes av många patienter som en kamp och ett lidande. De önskade att få fortsätta leva ett så normalt liv som möjligt och bibehålla självständigheten. Att inte längre kunna ta hand om sig själv upplevdes skapa ett stort beroende av andra och resulterade i en känsla av att vara en börda för familjen. Det var meningsfullt att spendera tid med familjen samt att få stöd. Vissa patienter upplevde en acceptans av livets slut och önskade att få dö fridfullt.  Slutsatser: De upplevelser som patienterna förmedlade i det palliativa skedet kan tyda på ett stort behov av att erhålla stöd på olika sätt, samt att självständighet och familjen spelar en viktig roll i patienternas livssituation. För att patienterna ska få bevara upplevelsen av att vara självständig och få en så god omvårdnad som möjligt, bör sjuksköterskan kommunicera och stödja patienterna samt sträva efter att de får uppleva delaktighet i den egna vården. / Background: The concept of palliative care is defined as an approach where the key objective is to improve the quality of life for patients and their relatives. The need for palliative care is substantial as more people are getting older. Nurses can meet patients in palliative stages in different health care settings and experience the knowledge as inadequate.  Aim: The aim was to describe patients experience of living with disease in a palliative stage, and to describe the selected articles study groups.  Method: Litterature review with a descriptive design including 13 articles with a qualitative approach, from the databases CINAHL and MEDLINE via PubMed. Main results: To live in a palliative stage was experienced by many patients like a struggle and suffering. They wanted to live their lives as normally as possible and to maintain their independence. To no longer being able to take care of themselves perceived to create a dependence on others and resulted in a feeling of being a burden to the family. It was meaningful to spend time with family and to receive support. Some patients experienced an acceptance of life ending and wished to die peacefully. Conclusions: The experiences that patients mediated in the palliative stage may indicate a great need to be supported in different ways, and that independence and the family plays an important role in patients' lives. To ensure that patients are preserving the experience of being independent and get as good care as possible, the nurse should communicate and support patients and strive to get the experience involvement in their own care.

Bakgrund: Fetma är idag ett ökat världsproblem och följden är att flera genomgår viktminskningsoperationen gastric bypass. Det är viktigt att upplevelserna ur ett fysiskt, psykiskt och socialt synsätt belyses för att ge en ökad förståelse samt att hjälpa dem i rätt riktning. Syfte: Att beskriva personers upplevelse av sin livssituation efter att ha genomgått en gastric bypass operation ur ett fysiskt, psykiskt och socialt perspektiv. Metod: En beskrivande litteraturstudie av elva stycken vetenskapliga artiklar. Huvudresultat: Efter operationen får personerna en mer positiv inställning till livet ur de tre perspektiven. De upplevde att de passade in i samhället, samt orkade delta i sociala och fysiska sammanhang. En tid efter operationen upplevde deltagarna att de föll tillbaka i gamla vanor vilket gav dem en sämre livskvalité. De belyste att operationen var ett verktyg och själva jobbet återstod och en utmaning väntades som vissa hanterade bättre en andra. Slutsatser: Det är viktigt att ge personerna bra stöttning och information för att de ska kunna bevara sin nya livsstil. De genomgår en stor psykisk påfrestning därför behövs det psykoterapi och vägledning till att finna en lämplig copingstratagi för att hantera olika situationer. / Background: Obesity is now a growing problem in the world and as a result, several do gastric bypass surgery for weight loss. It is important that the experiences from a physical, mental and social approach is illuminated to provide a better understanding and to help them to right direction. Aim: To describe the experience situation of life a one person after doing a gastric bypass surgery from a physical, psychological and social perspective. Method: A descriptive study of eleven scientific articles. Results: After a gastric bypass, the people have a more positive attitude towards life according the three perspectives. They experienced that they fit into society and could participate in the social and physical context in a better way than before. Sometime after the surgery, the participants experienced that they were back into the old habits which gave them a worse quality of life. They ment that the operation was a tool but the hard part remained and they expected a challenge, as some managed better than others. Conclusions: It is important to give people good support, and information to enable them to preserve their new lifestyle. They are making a great mental effort, therefore they are indeed of psychotherapy and guidence to find a suitable copingstrategy to handle different situations.

Some of the most interesting facets of Edgar Allan Poe's fiction are his imaginative speculations concerning the metaphysical experiences of the soul, the individual psychic "identity." His interest focuses primarily on three related aspects of the soul's experiences (1) metempsychosis (or reincarnation and transmigration); (2) suspension between "death" and the after-life or states of unconsciousness and consciousness, sleep and waking; and (3) the terrors, real or imagined, of premature burial.