The research question is: How do young people experience having a family member in prison? This question is posed within the Scottish policymaking context, in which high rates of imprisonment and reoffending are entrenched problems for the Scottish Government. In relation to children and young people, there has been a focus on the performance measurement of holistic policies accessed through the universal services of health, education and social work. Although there has been a growing awareness of some key issues that affect families affected by imprisonment, concern tends to be focused on parental imprisonment, ignoring wider family relationships. In addition, older teenagers and young adults have largely been overlooked. This stage of development is an important one, because it represents the time when young people make the transition into adulthood. As such, it is highly intertwined with issues relating to self-­‐identity. The thesis addresses the policies that are most relevant to young people, as well as the policies that more generally relate to families affected by imprisonment. It takes an approach informed by critical discourse analysis to critique the construction of young people and families, arguing that Scottish policymaking fails to address the core needs of these young people, and that the Scottish Government only deals with families affected by imprisonment at arms length. This leaves a policy gap, which third sector organisations step in to fill. The research includes empirical data from young people, who described their experience in open-­‐structured interviews. A thematic analysis of the interview data shows the complexity of the emotional state that young people enter when faced with the imprisonment of a parent, sibling or partner. A discussion of the resultant psychological effects, with reference to classic sociology of imprisonment literature, demonstrates that imprisonment is potentially traumatizing, causing feelings of isolation and a sense of being ignored or even silenced. The empirical data also includes semi-­‐structured interviews with professionals from third sector organisations, whose evidence shows that the policy environment presents a number of obstacles that block the way to providing appropriate services to young people. In addition, the topic of family imprisonment is under-­‐explored by the professionals and this increases the risk that young people will feel the need to stay silent. In conclusion, the thesis reviews the theoretical framework, the policymaking environment and the lived experience of the young people and the professionals who work with them to conclude that there is a pressing problem, which is inadequately understood, and which requires the more insightful approach that research such as this can help to inform.

The diagnosis of HIV is a life-changing event that requires people to deal with the disease, as well as cope with HIV stigma. Both people living with HIV or AIDS (PLHA) and their close family members (CFM) are stigmatized, but CFM also stigmatizes PLHA. This interaction affects the relationship between PLHA and their CFM. The aim of this study was to evaluate the effect of a comprehensive community-based HIV stigma reduction intervention on PLHA and their CFM as well as to explore and describe their experiences during and after the intervention. A holistic multiple case study design as well as a qualitative description approach was used. The study was conducted in both an urban and a rural setting. Purposive sampling was used for the PLHA and snowball sampling for the CFM. The case record for the case study consisted of several sources. In-depth-interviews were used to explore their experiences. The data was analysed using open coding and text document analysis. Both groups gained a richer understanding of HIV stigma and coping with it. The relationships enriched by PLHA feeling more supported and CFM realizing how they stigmatized and that they should be more supportive. Leadership was activated through the project. Bringing PLHA and CFM together during an intervention, proved to be affective, Recommendations focus on the inclusion of HIV-related stigma reduction awareness interventions in the curriculum of student nurses and the implementation thereof in the community, through community based nursing. It would be of benefit if the programme could also be offered as a workshop to traditional healers in the community. Nurses in clinics working with PLHA should invite PLHA and CFM to participate in groups to support each other in reducing HIV-related stigma and share problem-solving coping strategies. The researcher believes that the results of the current study have important implications for further research in HIV-related stigma reduction interventions in other countries and demographic groups. It has the potential to be used for long-term monitoring studies of HIV stigma reduction interventions and the change over time. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013

Background: In the year 2016 there were over 2 million acute ill adults who visited the emergency department and of those 2 million, 1,3 million were being remitted. The definition of being acute ill is a person who needed emergency care. The nurses' role in the emergency care was to evaluate and prioritize the acute ill medical need. In the acute situation the relatives were often put aside and that would cause a negative wellbeing experience. Aim: The purpose of the study was to investigate the relatives' experiences of having family members who became acute ill. Method: A literature study based on an analysis of eleven qualitative scientific articles was conducted. Results: The analysis resulted in two themes; Mixed feelings and experiences when a family member has become acutely ill and Experience in the meeting with a health professional. The results showed the importance of clear and understandable information from nurses. How the relatives were treated also had a significant impact on how they reacted to the acute situation. Conclusion: When a family member becomes acutely ill the relatives experienced the situation as difficult and were concerned over the family member's health. Despite that they were grateful for the opportunity to be present because they experienced that they were comforted and calmed. To have access to professional support and company helps the relatives to control and react to the situation. / I Sverige anländer ett stort antal personer till sjukhus som är i behov av akut omhändertagande och det är vanligt att dessa personer har med sig anhöriga. Sjuksköterskans ansvar är att bemöta och stötta både den sjuke familjemedlemmen och anhöriga i det akuta omhändertagandet. När anhöriga är närvarande upplever de blandade känslor. De känslor som dominerar är rädsla och oro. Anhöriga kan mötas av ett bristfälligt bemötande av sjuksköterskan samt uppleva att informationen som ges är oklar och svårförståelig. Det kan leda till att anhöriga känner att de blir åsidosatta vilket skapar känslor som övergivenhet, ångest och osäkerhet. Att bemöta anhöriga på rätt sätt kan göras genom att utgå från familjefokuserad omvårdnad, där sjuksköterskan ska se varje familj som en helhet. Vid rätt bemötande och information upplever anhöriga tacksamhet över att få möjlighet att vara nära sin sjuke familjemedlem. Detta skapar förtroende för vården och känslan av att få verktyg att hantera situationen. Vid en akut situation används anhörigstödjare som en resurs där deras uppgift är att förklara vad som händer/pågår och stödja anhöriga. När en familjemedlem blir akut sjuk kan anhöriga uppleva en förlust av kontroll över situationen och på detta sätt förändras deras livsvärld. Ett sätt att få tillbaka kontrollen är att få tillgång till rätt förmedlad information. Författarna väljer att göra ett litteraturbaserat examensarbete där 11 kvalitativa artiklar granskas. I examensarbetet framkommer det 2 teman och 4 underteman. Resultatet visar att anhöriga upplever blandade känslor när deras familjemedlem blir akut sjuk. Anhöriga upplever det viktigt att få möjlighet att ge stöd till sin sjuke familjemedlem. Dessutom minskar anhörigas stress om de får stöd från övrig familj och vänner. I mötet med vårdpersonalen har många anhöriga positiva känslor medan vissa anhöriga uppger negativa känslor såsom övergivenhet, osäkerhet, frustration och en känsla av att skapa obehag hos vårdpersonalen. Examensarbetets resultat ger sjuksköterskan en förståelse om vikten av ett bra bemötande och förmedlandet av förståelig information i mötet med anhöriga.

Bakgrund: Antalet personer som insjuknar i demenssjukdom ökar världen över. Behovet efter utbildad personal och sjuksköterskans ansvar att kunna ge stöd och hjälp till demenssjukas anhöriga ökar därför också då en demenssjukdom påverkar hela familjen. Syfte: Syftet är att beskriva anhörigas upplevelser av att ha en nära familjemedlem med demenssjukdom. Metod: En systematisk litteraturstudie enligt Evans (2002) analysmetod har använts för att analysera 12 stycken kvalitativa artiklar. Nyckelfynd sammanfördes och bildade tre teman och sex stycken subteman. Resultat: Resultatet påvisar att anhöriga upplever blandade känslor av att en nära familjemedlem fått diagnosen demenssjukdom. Dessa upplevelser delades in i livet efter diagnosen, förluster och förändrad delaktighet till vården av den demenssjuke. Viljan att vårda sin familjemedlem, en förändrad vardag, förlust av kontroll, förlust av social samvaro och egen identitet, lämna över ansvaret och vara delaktig i vården på boendet var de subteman som uppkom. Slutsats: I arbetet klargjordes en rad upplevelser anhöriga hade utifrån att ha en nära familjemedlem med demenssjukdom. Dessa upplevelser bör sjuksköterskan ta del av inför det stöd och den handledning som erbjuds anhöriga. Mer forskning bör göras angående den hjälp som ges till anhöriga till demenssjuka. / Background: The number of people diagnosed with dementia is increasing worldwide. The need for trained personnel and the nurse's responsibility to provide support and assistance to families of people with dementia therefore increases since dementia affects the whole family. Aim: The purpose is to describe the relatives' experiences of having a close family member with dementia. Method: A systematic literature review of Evans (2002) analysis was used to analyze the 12 pieces of qualitative articles. Key findings were merged and formed three themes and six subthemes. Results: The results indicate that families are experiencing mixed feelings of a close family member diagnosed with dementia. These experiences were divided into life after diagnosis, losses and changes in participation to the care of people suffering from dementia. The desire to care for their family member, a change in living, loss of control, loss of social interaction and self-identity, hand over responsibility and be involved in the care of the accommodation was the subthemes that arose. Conclusion: This essay was made clear a number of relatives had experiences from having a close family member with dementia. These experiences should the nurse take note of for the support and guidance offered to relatives. More research should be done about the help given to families of people with dementia.

The diagnosis of HIV is a life-changing event that requires people to deal with the disease, as well as cope with HIV stigma. Both people living with HIV or AIDS (PLHA) and their close family members (CFM) are stigmatized, but CFM also stigmatizes PLHA. This interaction affects the relationship between PLHA and their CFM. The aim of this study was to evaluate the effect of a comprehensive community-based HIV stigma reduction intervention on PLHA and their CFM as well as to explore and describe their experiences during and after the intervention. A holistic multiple case study design as well as a qualitative description approach was used. The study was conducted in both an urban and a rural setting. Purposive sampling was used for the PLHA and snowball sampling for the CFM. The case record for the case study consisted of several sources. In-depth-interviews were used to explore their experiences. The data was analysed using open coding and text document analysis. Both groups gained a richer understanding of HIV stigma and coping with it. The relationships enriched by PLHA feeling more supported and CFM realizing how they stigmatized and that they should be more supportive. Leadership was activated through the project. Bringing PLHA and CFM together during an intervention, proved to be affective, Recommendations focus on the inclusion of HIV-related stigma reduction awareness interventions in the curriculum of student nurses and the implementation thereof in the community, through community based nursing. It would be of benefit if the programme could also be offered as a workshop to traditional healers in the community. Nurses in clinics working with PLHA should invite PLHA and CFM to participate in groups to support each other in reducing HIV-related stigma and share problem-solving coping strategies. The researcher believes that the results of the current study have important implications for further research in HIV-related stigma reduction interventions in other countries and demographic groups. It has the potential to be used for long-term monitoring studies of HIV stigma reduction interventions and the change over time. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013

This thesis describes a qualitative study exploring the use of critical care diaries from the experiences and perspectives of patients, family members and nurses in a Scottish Intensive Care Unit (ICU). Diaries are currently used in some ICUs across Europe, the UK, Australia and other countries to help patients come to terms with the experience of critical illness. Started in the ICU, the diary is written at the bedside by nurses and family members providing an account of what happened when the patient was in ICU. Following discharge, the diary is handed over to the patient for them to read and refer to during their recovery. Therefore, the diary is used by different people, at different times and in different ways throughout the critical illness journey. However, until recently, research has mainly focused on the diary being read by the patient after ICU as an aid to recovery with little known about family members and nurses despite them being the main authors during the time in ICU. This doctoral research was designed to explore critical care diaries from multiple perspectives and experiences to gain a greater understanding of the different ways in which diaries can be used. Furthermore, it is the first known research study in this area to have been undertaken in NHS Scotland where the use of diaries remains a relatively new practice. The theoretical perspective of Symbolic Interactionism helped to inform the development and design of the research study. A focused ethnographic approach was taken to explore the use of critical care diaries from the different groups identified, during and after a stay in ICU. The setting was an Adult ICU in Scotland where diaries were being used as part of a follow up service for patients and family members after ICU. Data were collected from February 2013 to June 2014. Semi-structured interviews were the main method of data collection. A purposive sampling strategy was adopted to recruit participants in triads with a related patient, family member and nurse involved in their care during the time in ICU. This is a novel and unique approach to research in this area. Four complete triads and two incomplete triads were recruited giving a total of sixteen interviews with four patients, six family members and six nurses. Interviews were supplemented with a small number of formal observations of nurses carrying out diary related activities (n=9) and field notes from time spent at the site. Transcribed interview data were analysed using a thematic approach, uncovering five main themes: (1) Information; (2) Communication; (3) Emotion; (4) Person Centered and (5) Gender. The concept of ‘Stories as joint actions’ developed by the sociologist Ken Plummer in 1995 was used as a framework to discuss and explain the findings. Diaries were found to support information sharing and facilitate communication interactions between nurses, family members and patients in the ICU as well as promoting and demonstrating a person centered approach to care. Emotional support was experienced by family members from writing in and reading the diary during the time in ICU whereas patients experienced emotional support from reading diary entries after the time in ICU. However emotional effort was associated with reading and writing in the diary during and after the time in ICU for patients, family members and nurses. Male family members were found to be less likely to write in the diary compared to female family members. Factors such as gender and literacy appeared to influence diary use however this requires further investigation. A new conceptual model ‘Critical Care Diaries as Joint Actions’ was created to address the complex nature of experiences with critical care diaries. Exploring the use of diaries from multiple perspectives and experiences has provided valuable insight into the different ways in which diaries are used during and after the time in ICU demonstrating that although the diary is primarily written for the patient, family members, nurses and patients use the diary in different ways to support their needs and others needs throughout the experience of critical illness.

Bakgrund: Alkoholproblematik är ett stort problem som påverkar den enskilda personen, anhöriga och samhället. Lagar och riktlinjer slår fast att anhöriga ska erbjudas stödinsatser. Sjuksköterskans etiska kod omfattar både den enskilda individen, anhöriga och samhället. Tidigare studier har uppmärksammat livssituation och hälsa hos anhöriga till personer med psykisk ohälsa, men det saknas studier kring anhöriga till personer med alkoholproblem. Syfte: Syftet med denna studie var att beskriva livssituationen med särskilt fokus på hälsa hos vuxna anhöriga till personer med alkoholproblematik. Metod: Studien har en kvalitativ design med induktiv ansats. Sex vuxna anhöriga till personer med alkoholproblematik intervjuades individuellt med halvstrukturerad metod enligt Kvale och Brinkmann. Intervjumaterialet analyserades enligt Elo och Kyngäs metod för kvalitativ innehållsanalys. Resultat: Resultatet från intervjuerna utmynnade i fyra kategorier: En otrygg och ansvarstagande livssituation, Att leva för den andra och förlora sig själv, Variation av starka känslor samt Att komma vidare i livet och försonas med sig själv. Diskussion: Studiens metod diskuteras utifrån Graneheim och Lundmans kvalitetsbegrepp. Centrala fynd i resultatet diskuteras i relation till tidigare forskning samt Antonovskys teori om känsla av sammanhang (KASAM). / Background: Alcohol problems is a major problem that affects the individual, family and society. Laws and guidelines states that family members must be offered support. Nurse’s Code of Ethics includes both the individual, family and society. Previous studies have drawn attention to life situation and health of family members of persons with mental illness, but there is a lack of studies of family members of persons with alcohol problems. Aim: The aim of this study was to describe the life situation with a particular focus on health in adult family members of persons with alcohol problems. Method: The study has a qualitative design with an inductive approach. Six adult family members of persons with alcohol problems were interviewed individually with semi-structured method by Kvale and Brinkmann. The interview material was analysed using Elo and Kyngäs method of qualitative content analysis. Results: The results from the interviews resulted in four categories: An insecure and responsible life situation, To live for the other and lose yourself, Variety of strong emotions and To move on in life and to reconcile with yourself. Discussions: The study’s method is discussed based on Graneheim and Lundmans quality concepts. Central findings in the results are discussed in relation to previous research and Antonovsky’s theory of sense of coherence (SoC).

Bakgrund: Intensivvårdsavdelningen är en avdelning där kritiskt- och akut sjuka patienter vårdas. Avdelningen har specialiserade rutiner och utrustning för omvårdnad samt övervakning. Sjuksköterskan på en intensivvårdsavdelning har ansvar över omvårdnaden av patienten tillsammans med ledandet av omvårdnadsarbetet i vårdlaget. Utöver har även sjuksköterskan ett ansvar att uppmärksamma den anhöriga. Därför är det viktigt för sjuksköterskan att förstå anhörigas upplevelser i denna situation för att kunna ge en god omvårdnad även till dem. Syfte:  Att beskriva anhörigas upplevda situation när en närstående vårdas på en intensivvårdsavdelning. Metod: Litteraturöversikt av vetenskapliga artiklar med kvalitativ ansats med ett anhörigperspektiv för att belysa upplevelser. Resultat: Anhöriga kunde uppleva flera faktorer som påverkade situationen negativt. Rutiner, teknisk utrustning och vårdinsatser upplevdes främmande och förvirrande. Situationen gjorde det svårt för den anhörige att uppleva sig nära patienten. Anhöriga upplevde att god kommunikation och information påverkade situationen positivt. Anhöriga upplevde det viktigt att kunna vara delaktig i vården och beslutsfattandet. Slutsats: Att som anhörigas hamna på en intensivvårdsavdelning är en främmande situation som skiljer sig från andra avdelningar. Det finns olika regler, utrustning och situationer som försvårar möjligheten för den anhörige att förstå och se sammanhanget. Det är av betydelse att vården uppmärksammar och skapar möjlighet för en ökad förståelse och ett sammanhang för de anhöriga. / Background: The intensive care unit is a department where critically and acute sick patients are being treated. The department has specialized routines, equipment to treat and screening. Nurses on a intensive care unit are responsible for the treatment of patients as well as the leadership of the workforce. The nurses are also responsible to acknowledge the patient’s relatives. Therefore, it is of great importance for the nurses to understand relatives’ experiences in this situation, to be able to give treatment of good quality to relatives too. Aim: To describe the experience of relatives to patients who are being treated at the intensive care unit. Method: A literature review of scientific articles with a qualitative standpoint, aimed towards the experiences of relatives to intensive care unit patients. Results: Relatives experienced that a lot of factors affected them negatively. Routines, equipment and treatment were experienced as unfamiliar and confusing. The situation made it hard for the relatives to experience being close to the patient. Relatives experienced that good communication and information made the situation positive. Relatives experienced that being a part and having a say in the patients’ treatment were important. Conclusion: To be a relative at the intensive care unit can feel unfamiliar and differ from other kinds of departments. There are rules, equipment and situations that makes it difficult for the relatives to see the context of the situation. It is of great importance that the healthcare is attentive and give the relatives the possibility to understand the context.

Syftet med den här undersökningen var att beskriva hur anhöriga upplever och hanterar sin livssituation, med fokus på familjen och deras egen hälsa, under den akuta fasen vid allogen stamcellstransplantation. Undersökningen ägde rum på Centrum för Allogen Stamcellstransplantation vid Karolinska Universitetssjukhuset Huddinge. Sju anhöriga till patienter som genomgick en allogen stamcellstransplantation deltog. Metoden som användes var att genom semistrukturerade intervjuer låta anhöriga själva berätta om sin livssituation. Dessa intervjuer analyserades sedan med hjälp av kvalitativ innehållsanalys vilket resulterade i att temat den nuvarande situationen formulerades. Temat bestod av tre kategorier livspussel, familj och hälsa och hade tio underkategorier totalt. Resultatet blev att när anhöriga får berätta om hur de upplever sin livssituation berättar de om hur de mobiliserar och fokuserar all sin kraft och alla sina resurser till den nuvarande situationen som de befinner sig i. Slutsatsen blev att vidare forskning för att utveckla interventioner för dessa anhöriga behövs, där sårbarhet upptäcks och inre och yttre resurser uppmärksammas och stärks. Att fokusera på anhöriga och den sjuka familjemedlemmen samtidigt, som en enhet, främjar hela familjens hälsa och medför därför en vinst, inte bara för de anhöriga utan även för patienten och dess tillfrisknande. / The aim of this study was to describe family members’ experience of life during the acute phase of allogenic stem cell transplantation. Seven family members of patients at, “Centrum for Allogenic Stem cell transplantation” Karolinska University Hospital in Huddinge participated. The method used was semistruktured interviews that allowed the respondents to tell about their living situation. These interviews were then analyzed through qualitative content analysis. The findings were a theme named; this present time consisting of three categories: living-pieces, family and health. There were also ten subcategories all together. The result was that when family members gives the opportunity to, with their own words, describe and tell about their living situation they tell about the present time and how they focus and mobilise all their strength and energy on their sick family member to get well. The conclusion of this study was that further research and development of interventions, for family members, are necessary and to focus on the family as a unite is an absolute condition in order to maintain health and prevent physical- and mental illness for the whole family. This ought to be beneficial not only for the family but also for the patients’ recovery.

Bakgrund: När en familjemedlem insjuknar i demenssjukdom påverkas hela familjen. Närstående blir involverade i omvårdnaden för familjemedlemmen som lever med en demenssjukdom. Sjuksköterskan har en viktig roll i att ge information och stöd till närstående för att uppleva en hanterbar tillvaro. Att kunna förespråka upplevelser och behov hos både närstående och personen med demenssjukdom kan vara utmanande i arbetet för sjuksköterskan. Syfte: Att beskriva närståendes upplevelser av att leva med en familjemedlem som har en demenssjukdom. Metod: Litteraturöversikt med kvalitativ design. Tolv artiklar gick igenom kvalitetsgranskningen och analyserades induktivt genom Fribergs femstegsmodell vilket resulterade i fem kategorier. Resultat: Närstående upplevde att det egna jaget samt relationen till familjemedlemmen förändrades. Att vårda en familjemedlem var emotionellt påfrestande och vardagen påverkas både socialt, ekonomiskt samt närståendes arbetsliv. Även omgivningen påverkade närstående, delvis huruvida omgivningen såg på familjemedlemmen samt vilket stöd närstående upplevde att de fick. Slutsats: Att kunna ge stöd och information till närstående har påvisat vara bristfällig. Sjuksköterskan behöver ha en djupare förståelse kring hur närstående påverkas i vardagen, både fysiskt och psykiskt. Vidare finns behov för utveckling av nya rutiner samt strategier kring hur det ska bli mer tydligt för sjuksköterskan att tillgodose närståendes behov av stöd. / Background: When a family member is affected with dementia, the entire family gets affected. Relatives are involved in the care of a family member living with dementia. The nurse has an important role in providing information and support for relatives, so they can experience a manageable everyday life. Being able to advocate experiences and needs for the relative and the person with dementia can be challenging for the nurse. Objective: To describe relatives´ experiences of living with a family member who has dementia. Method: Literature overview with qualitative design. Twelve articles passed the quality review protocol and were inductively analyzed by Friberg's five-step model, resulting in five categories. Result: Relatives´ experiences that their own self as well as the relationship with family members changed. Caring for a family member was emotionally strenuous and everyday life was affected socially, economically as well as their working lives. The surrounding area affected the relatives, partly how the surroundings looked at the family member and what kind of support the relatives´ experienced that they were given. Conclusion: Being able to provide support and information to relatives has proven to be inadequate. The nurse needs a deeper understanding of how relatives are affected in everyday life, both physically and mentally. Furthermore, there is a need for development of new routines as well as strategies on how it becomes clearer for the nurse to meet the relatives needs of support.