Qualitative, exploratory and descriptive research study was conducted using the case study approach. The purpose of this study was to explore and describe the experiences of family members caring for a long term mentally ill patient suffering from schizophrenia. Purposive sampling was used to select one family who cared for the patient for more than two years. Data was collected through the process of in-depth, unstructured individual interviews. Interviews were tape recorded and transcribed verbatim. Themes, categories and sub-categories were finally identified. The findings revealed that although the family was willing to care for the patient at home, they experienced challenges to provide basic care. Other challenges included were lack of adherence to treatment, financial constraints, substance abuse, social stigma, fear and concerns about the patient’s future. A conceptual map was designed to reflect the major concepts of the findings / Health Studies / M.A. (Health Studies)

Studies have indicated that relapse is noted as a major problem facing mental health services both nationally and internationally whereby family members caring for mental health care users experience a serious burden. Factors commonly associated with relapse include poor adherence to treatment, substance abuse, co-morbid psychiatric illness, a co-morbid medical and or surgical condition, stressful life events and the treatment setting. Relapse prevention strategies have been identified and they include, empowering people with mental illness to recognize early warning signs of relapse in order to develop appropriate response plans as well as communication and understanding between the mentally ill person, their family, and specialist mental health system and community support services. The researcher was prompted by the problem of relapse faced by mental health services to explore and describe the strengths of families in assisting mental health care users to limit relapse and to formulate guidelines for psychiatric nurses to empower family members caring for mental health care users to limit relapse. A phenomenological design was used in this study and a purposive sampling technique was used to select participants who met the selection criteria. In-depth individual interviews were conducted with 15 family members. All interviews were recorded with an audio recorder after participants gave consent. Data saturation was achieved after 13 participants were interviewed and further two interviews confirmed data saturation. Field notes were written immediately after each interview. Data analysis was done according to Tesch as quoted by Creswell (2007:187) and the researcher and co-analyzer reached consensus on the themes in a meeting. The findings of research resulted in four main categories namely, accepting the condition of a mentally ill family member, having faith in God, involving a mentally ill family member in daily activities and being aware of what aggravates the mentally ill family member. The conclusion that can be made is that “acceptance through education” assisted family members in developing a positive attitude and acceptance of their feelings as well as the condition of their mentally ill family members. A strong spiritual base provides family members with strength and hope in times of adversity and teaches them how to have healthy relationships within the family unit and with others. It is also evident that sharing activities, as the things that all members of the family do together, reinforce and strengthen their togetherness and that if family members can be aware of what aggravates mentally ill family members by communicating well with them, that can bring harmony in families and ultimately limit relapse. Recommendations in this research are made for nursing education, nursing research and psychiatric nursing practice with guidelines for psychiatric nurses to empower families caring for mentally ill family members to use their strengths and contribute to limiting relapse. / MCur, North-West University, Potchefstroom Campus, 2014

Bakgrund: Ur ett historiskt perspektiv har det inom intensivvård skett stora förändringar över tid. I och med denna utveckling har patienter idag bättre förutsättningar till överlevnad och fortsatt liv. Detta medför dock att det i högre grad uppstår etiska frågor på intensivvårdsavdelningarna vilka berör livsuppehållande behandling, medicinsk meningslös behandling, att bibehålla patientens autonomi samt omvårdnad i livets slutskede. Syfte: Syftet med studien var att få ökad förståelse för intensivvårdssjuksköterskors upplevelser av etiskt svåra situationer som kan uppstå när intensivvård för svårt sjuka patienter inte är kurativ. Metod: En kvalitativ intervjustudie med ett ändamålsenligt urval genomfördes. Inklusionskriterierna var specialistsjuksköterskeexamen samt minst två års erfarenhet av intensivvård. Data bearbetades utifrån kvalitativ innehållsanalys. Resultat: Ett tema och tre kategorier formades utifrån data som insamlats. Tema: En vilja att göra gott, men vad är det? Kategorier: Att ha tillgång till avancerad vård löser inte alla problem. Att vara den som verkställer åtgärder som man inte alltid förstår eller samtycker med. Att bemöta närstående är en viktig men komplicerad del av vårdandet. Det funna resultatet visade på svårigheter som intensivvårdssjuksköterskorna stötte på i den högspecialiserade vården som är inriktad på att upprätthålla vitala funktioner hos patienter samt att rädda liv. Svårigheter uppstod när de förstod att patientens liv inte skulle gå att räddas, i mötet med närstående och i samspelet med läkarna samt intensivvårdssjuksköterskans egna känslor kring handlingar och fenomen. Konklusion: Intensivvårdssjuksköterskorna upplever att etik ofta stå tillbaka till förmån för att rädda livet på patienten. De medicinska perspektiven är högst rankade på intensivvårdsavdelningen, detta trots att de etiskt svåra situationerna ständigt är närvarande. I de mest krävande patientmötena underlättar det för intensivvårdssjuksköterskan att hen är väl förankrad i besluten som har tagits, förstår beslutet samt känner förtroende för och har uppbackning av läkaren. Även det kollegiala samspelet med andra yrkesgrupper kan stödja intensivvårdssjuksköterskan i de etiskt svåra situationerna.

Qualitative, exploratory and descriptive research study was conducted using the case study approach. The purpose of this study was to explore and describe the experiences of family members caring for a long term mentally ill patient suffering from schizophrenia. Purposive sampling was used to select one family who cared for the patient for more than two years. Data was collected through the process of in-depth, unstructured individual interviews. Interviews were tape recorded and transcribed verbatim. Themes, categories and sub-categories were finally identified. The findings revealed that although the family was willing to care for the patient at home, they experienced challenges to provide basic care. Other challenges included were lack of adherence to treatment, financial constraints, substance abuse, social stigma, fear and concerns about the patient’s future. A conceptual map was designed to reflect the major concepts of the findings / Health Studies / M.A. (Health Studies)

Made available in DSpace on 2016-04-28T20:38:06Z (GMT). No. of bitstreams: 1 Tatiana de Freitas Munia Barbosa.pdf: 1470548 bytes, checksum: 904bf9649fde69ae79426f93b238aae6 (MD5) Previous issue date: 2012-05-14 / Nowadays, drug abuse is a subject that is heavily divulgated and discussed. The drug abuse have increased drastically since the sec. XX. Therefore, it‟s sure that there is a necessity for scientific study in this area, so we will have the knowledge and direction needed for treatments and preventions of drug dependence. This study aim to verify how therapy in group, with the family members of the drug dependence- while getting a deeper comprehension of this issue transferring the problem from the dependent to the family group- collaborates with the progress of the individual, in terms of more adhesion, as we consider the situation as a whole, and so we can get better results for the treatment. Realizing the importance of the family, this theme will be adopted by the view of systemic approach. This is a qualitative study with a mixed methodology character: family therapy, genograms and semi-structurated interviews, using as a base the narratives of the members, because we understand that the meanings are built socially. The study was done in a therapeutic community in São Jose do Rio Preto, state of São Paulo. Nine families participated of the study, and was realized eight sections in group. The results, showed how the members of the family was re-mean their narratives and their behavior throughout the sections. It became clear that the group therapy is very productive, because they pass through the same difficulties, seek for help in each other, talk through the experiences they have being through, and so they get stronger. Plus, the family member has to be seen and treated as the key-word in the treatment process of drug dependence, contributing to the improvement of the familiar relationship, increasing the possibility of the dependent motivated himself and keep in treatment / A dependência de drogas na atualidade é um fenômeno amplamente divulgado e discutido, visto que o consumo de drogas cresceu assustadoramente a partir do século XX. Portanto, fica evidenciada a necessidade da construção de estudos científicos nesta área, para a compreensão e direcionamento de ações preventivas e de tratamento. Esta pesquisa teve como objetivo estudar como a terapia familiar em grupo com os familiares dos dependentes ao gerar uma compreensão mais ampla do problema, então deslocado do membro dependente para o grupo familiar , colabora para o progresso do tratamento desse membro, em termos de maior adesão e melhores resultados do tratamento. Pelo fato de priorizarmos a importância da família, este tema será abordado sob o prisma do pensamento sistêmico. Assim, efetuamos uma pesquisa qualitativa de caráter multimetodológico: terapia familiar em grupo, genograma e entrevistas semiestruturadas, utilizando como base as narrativas dos participantes, pois compreendemos que os significados são construídos socialmente. O estudo foi desenvolvido em uma comunidade terapêutica na cidade de São José do Rio Preto, São Paulo. Participaram do estudo nove famílias e foram realizadas oito sessões em grupo com os familiares. Os resultados mostram como os participantes da pesquisa foram, por meio das narrativas, ressignificando seus comportamentos e suas mudanças nos grupos terapêuticos. Ficou evidenciado que a terapia em grupo é muito produtiva, porquanto os indivíduos enfrentam as mesmas dificuldades, se apoiam, compartilham as experiências vividas e com isto se fortalecem, e também que o familiar deve ser considerado e tratado como uma das peças-chave no processo de recuperação da dependência de drogas, contribuindo para a melhoria das relações familiares e ampliando a possibilidade de o dependente motivar-se e manter-se em tratamento

<p>Abstrakt</p><p>Gråt är vanlig bland patienter och närstående men sällan studerat i palliativ vård. Gråten kan vara ett sätt för patienter och deras närstående att uttrycka sorg och hantera en situation fylld av stress som är orsakad av förluster, många allvarliga symtom och en nära förestående död.</p><p>Studiernas övergripande syfte var att bidra till en djupare förståelse för vilken betydelse gråten har för patienter och deras närstående i palliativ hemsjukvård: Vad innebär gråten och hur påverkar den de berörda? Bandinspelade intervjuer gjordes med 14 patienter med cancersjukdom och 14 närstående i palliativ hemsjukvård. För att få en djupare förståelse genomfördes arbetet med ett hermeneutiskt metodologiskt angreppssätt enligt Gadamer.</p><p>Resultatet visade att patienterna (studie I) beskrev olika dimensioner och funktioner av gråt; Intensiv och förtvivlad gråt för att ge uttryck för akuta behov: Stilla och sorgsen gråt som medvetet förlöste känslor; Tyst och tårlös gråt som en skyddande strategi. Som en tolkning av helheten sågs patienternas gråt (studie I) som ett sätt att uttrycka en inre känslomässig kraft, framkallad av olika faktorer, som orsakade förändringar i den nuvarande inre balansen. Genom att gråta öppet men också inombords skapades eller upprätthölls balansen. Studie (II) visade att de närstående upplevde att gråten var beroende av olika förutsättningar som attityder och mod, tid, trygghet, ärliga och tillitsfulla relationer. Omskakande och oroande händelser, utmattning i brist på egen tid och sympati från andra var omständigheter som utlöste gråten. De närstående försökte göra det bästa möjliga för patienten genom att anpassa eller dölja gråten, allt för att underlätta bördan och skapa en positiv motvikt till lidande och sorg. Tolkningen av helheten (studie II); närståendes gråt kunde vara ett uttryck för att dela något tillsammans för gemenskap, tröst och stöd eller att söka sig till ensamhet för enskildhet och återhämtning.</p><p>Sammanfattningsvis kan gråten ses som en copingstrategi eftersom den reducerar spänningar och skapar befrielse, upprätthåller balans, ger tröst, ny energi och tillfällen för enskildhet. Det är ett sätt att uttrycka lidande men på samma gång kräver gråten energi och ger känslor av skam.</p><p>En viktig del i professionens arbete bör därför vara att tillåta gråten, lyssna, vara närvarande, uppmuntra uttryck av känslor men också ge utrymme för enskildhet. Läkaren, sjuksköterskan och andra i teamet kan lindra patientens och närståendes känslor av skam och sårbarhet genom att bekräfta, legitimera olika uttryck för gråt och därmed skapa en tolerant, säker och trygg omgivning.</p> / <p>Abstract</p><p>Crying among patients and family members is common but seldom studied in palliative care. It could be one way of expressing grief and of coping with a stressful situation caused by loss, severe symptoms and the impending death.</p><p>The overall aim of the studies was to contribute to a deeper understanding about the significance of crying for patients and family members in a palliative care setting: What is the significance of crying and how does it influence those involved? Tape-recorded interviews with 14 patients with cancer disease and 14 family members in palliative home care were carried out. In order to gain a deeper understanding a hermeneutic methodological approach according to Gadamer was used.</p><p>The results (Study I) show that patients describe crying in different dimensions and functions; Intense and despondent crying as a way of ventilating urgent needs; Gentle, sorrowful crying as a conscious release of emotions; Quiet, tearless crying as a protection strategy. As an interpretation of the whole (Study I): for the patients, crying seems to be an expression for an inner emotional force, provoked by different factors, which cause changes in the present balance. To cry openly but also to cry on the inside meant being able to achieve or maintain balance. The family members (Study II) perceived that crying was dependent on different prerequisites for crying such as attitude and courage, time, feeling secure, honest and trusting relationships. Uncertainty and turbulence situations, exhaustion due to lack of their own time and sympathy from others were circumstances that triggered crying. Family members tried to do the best possible for the patients by adapting or hiding their crying, in order to ease the burden and to create a positive counterbalance to suffering and grief. Interpretation of the whole (Study II): for the family members crying could be expressed as something to share with someone for support and consolation or an escape to solitude for integrity and respite.</p><p>In conclusions crying can be seen as a way of coping, as in many cases it reduces tension and creates release, maintains balance, brings comfort, new energy and opportunities for privacy. It is a way of expressing suffering, but at the same time it consumes energy and creates feelings of shame.</p><p>As suitable interventions, professionals should therefore legitimise crying, listen, be present, encourage the expression of feelings but also provide time and space for privacy. Staff may ease the patient’s and family member’s feelings of embarrassment and vulnerability by confirming and legitimating crying expressions by creating a tolerant, secure and safe environment.</p>

<p>Insufficient competence among nursing staff is a major concern in elderly care worldwide as the healthcare needs of the elderly become increasingly complex. In previous research, insufficient competence has been associated with work dissatisfaction and stress among elderly care nurses, and with lower quality of care. This thesis describes the development, implementation and evaluation of an educational intervention for nursing staff in elderly care. In a prospective, controlled study, evaluation of the educational toolbox was based on nursing staff ratings of their competence and psychosocial work environment, as well as on care recipients’ and family relatives’ ratings of the quality of elderly care.</p><p>Paper I validated a questionnaire measuring care recipient relatives’ perceptions of quality of care. Paper II compared self-rated competence, work strain, stress, and work satisfaction between staff working in home-based care and nursing homes. Papers III and IV evaluated the impact of the educational intervention on staff perceptions of their competence and psychosocial work environment (Paper III) and on care recipients’ and relatives’ perceptions of the quality of care (Paper IV).</p><p>The results showed that staff ratings of their competence and psychosocial work environment, including work satisfaction and work stress, improved significantly over time in the intervention municipality, compared to the reference group. Neither care recipients’ nor relatives’ ratings of the quality of care changed significantly over time in the intervention organization. Furthermore, there were no significant interaction effects over time between the intervention and reference groups for quality ratings. These results indicate that an educational toolbox that can be used according to local workplace needs may be an effective and sustainable intervention for improving staff competence and the psychosocial work environment. However, further studies are needed to investigate whether, and under what conditions, improved staff competence and work environment have an impact on quality of care.</p>

Insufficient competence among nursing staff is a major concern in elderly care worldwide as the healthcare needs of the elderly become increasingly complex. In previous research, insufficient competence has been associated with work dissatisfaction and stress among elderly care nurses, and with lower quality of care. This thesis describes the development, implementation and evaluation of an educational intervention for nursing staff in elderly care. In a prospective, controlled study, evaluation of the educational toolbox was based on nursing staff ratings of their competence and psychosocial work environment, as well as on care recipients’ and family relatives’ ratings of the quality of elderly care. Paper I validated a questionnaire measuring care recipient relatives’ perceptions of quality of care. Paper II compared self-rated competence, work strain, stress, and work satisfaction between staff working in home-based care and nursing homes. Papers III and IV evaluated the impact of the educational intervention on staff perceptions of their competence and psychosocial work environment (Paper III) and on care recipients’ and relatives’ perceptions of the quality of care (Paper IV). The results showed that staff ratings of their competence and psychosocial work environment, including work satisfaction and work stress, improved significantly over time in the intervention municipality, compared to the reference group. Neither care recipients’ nor relatives’ ratings of the quality of care changed significantly over time in the intervention organization. Furthermore, there were no significant interaction effects over time between the intervention and reference groups for quality ratings. These results indicate that an educational toolbox that can be used according to local workplace needs may be an effective and sustainable intervention for improving staff competence and the psychosocial work environment. However, further studies are needed to investigate whether, and under what conditions, improved staff competence and work environment have an impact on quality of care.

Abstrakt Gråt är vanlig bland patienter och närstående men sällan studerat i palliativ vård. Gråten kan vara ett sätt för patienter och deras närstående att uttrycka sorg och hantera en situation fylld av stress som är orsakad av förluster, många allvarliga symtom och en nära förestående död. Studiernas övergripande syfte var att bidra till en djupare förståelse för vilken betydelse gråten har för patienter och deras närstående i palliativ hemsjukvård: Vad innebär gråten och hur påverkar den de berörda? Bandinspelade intervjuer gjordes med 14 patienter med cancersjukdom och 14 närstående i palliativ hemsjukvård. För att få en djupare förståelse genomfördes arbetet med ett hermeneutiskt metodologiskt angreppssätt enligt Gadamer. Resultatet visade att patienterna (studie I) beskrev olika dimensioner och funktioner av gråt; Intensiv och förtvivlad gråt för att ge uttryck för akuta behov: Stilla och sorgsen gråt som medvetet förlöste känslor; Tyst och tårlös gråt som en skyddande strategi. Som en tolkning av helheten sågs patienternas gråt (studie I) som ett sätt att uttrycka en inre känslomässig kraft, framkallad av olika faktorer, som orsakade förändringar i den nuvarande inre balansen. Genom att gråta öppet men också inombords skapades eller upprätthölls balansen. Studie (II) visade att de närstående upplevde att gråten var beroende av olika förutsättningar som attityder och mod, tid, trygghet, ärliga och tillitsfulla relationer. Omskakande och oroande händelser, utmattning i brist på egen tid och sympati från andra var omständigheter som utlöste gråten. De närstående försökte göra det bästa möjliga för patienten genom att anpassa eller dölja gråten, allt för att underlätta bördan och skapa en positiv motvikt till lidande och sorg. Tolkningen av helheten (studie II); närståendes gråt kunde vara ett uttryck för att dela något tillsammans för gemenskap, tröst och stöd eller att söka sig till ensamhet för enskildhet och återhämtning. Sammanfattningsvis kan gråten ses som en copingstrategi eftersom den reducerar spänningar och skapar befrielse, upprätthåller balans, ger tröst, ny energi och tillfällen för enskildhet. Det är ett sätt att uttrycka lidande men på samma gång kräver gråten energi och ger känslor av skam. En viktig del i professionens arbete bör därför vara att tillåta gråten, lyssna, vara närvarande, uppmuntra uttryck av känslor men också ge utrymme för enskildhet. Läkaren, sjuksköterskan och andra i teamet kan lindra patientens och närståendes känslor av skam och sårbarhet genom att bekräfta, legitimera olika uttryck för gråt och därmed skapa en tolerant, säker och trygg omgivning. / Abstract Crying among patients and family members is common but seldom studied in palliative care. It could be one way of expressing grief and of coping with a stressful situation caused by loss, severe symptoms and the impending death. The overall aim of the studies was to contribute to a deeper understanding about the significance of crying for patients and family members in a palliative care setting: What is the significance of crying and how does it influence those involved? Tape-recorded interviews with 14 patients with cancer disease and 14 family members in palliative home care were carried out. In order to gain a deeper understanding a hermeneutic methodological approach according to Gadamer was used. The results (Study I) show that patients describe crying in different dimensions and functions; Intense and despondent crying as a way of ventilating urgent needs; Gentle, sorrowful crying as a conscious release of emotions; Quiet, tearless crying as a protection strategy. As an interpretation of the whole (Study I): for the patients, crying seems to be an expression for an inner emotional force, provoked by different factors, which cause changes in the present balance. To cry openly but also to cry on the inside meant being able to achieve or maintain balance. The family members (Study II) perceived that crying was dependent on different prerequisites for crying such as attitude and courage, time, feeling secure, honest and trusting relationships. Uncertainty and turbulence situations, exhaustion due to lack of their own time and sympathy from others were circumstances that triggered crying. Family members tried to do the best possible for the patients by adapting or hiding their crying, in order to ease the burden and to create a positive counterbalance to suffering and grief. Interpretation of the whole (Study II): for the family members crying could be expressed as something to share with someone for support and consolation or an escape to solitude for integrity and respite. In conclusions crying can be seen as a way of coping, as in many cases it reduces tension and creates release, maintains balance, brings comfort, new energy and opportunities for privacy. It is a way of expressing suffering, but at the same time it consumes energy and creates feelings of shame. As suitable interventions, professionals should therefore legitimise crying, listen, be present, encourage the expression of feelings but also provide time and space for privacy. Staff may ease the patient’s and family member’s feelings of embarrassment and vulnerability by confirming and legitimating crying expressions by creating a tolerant, secure and safe environment.

Studies have indicated that relapse is noted as a major problem facing mental health services both nationally and internationally whereby family members caring for mental health care users experience a serious burden. Factors commonly associated with relapse include poor adherence to treatment, substance abuse, co-morbid psychiatric illness, a co-morbid medical and or surgical condition, stressful life events and the treatment setting. Relapse prevention strategies have been identified and they include, empowering people with mental illness to recognize early warning signs of relapse in order to develop appropriate response plans as well as communication and understanding between the mentally ill person, their family, and specialist mental health system and community support services. The researcher was prompted by the problem of relapse faced by mental health services to explore and describe the strengths of families in assisting mental health care users to limit relapse and to formulate guidelines for psychiatric nurses to empower family members caring for mental health care users to limit relapse. A phenomenological design was used in this study and a purposive sampling technique was used to select participants who met the selection criteria. In-depth individual interviews were conducted with 15 family members. All interviews were recorded with an audio recorder after participants gave consent. Data saturation was achieved after 13 participants were interviewed and further two interviews confirmed data saturation. Field notes were written immediately after each interview. Data analysis was done according to Tesch as quoted by Creswell (2007:187) and the researcher and co-analyzer reached consensus on the themes in a meeting. The findings of research resulted in four main categories namely, accepting the condition of a mentally ill family member, having faith in God, involving a mentally ill family member in daily activities and being aware of what aggravates the mentally ill family member. The conclusion that can be made is that “acceptance through education” assisted family members in developing a positive attitude and acceptance of their feelings as well as the condition of their mentally ill family members. A strong spiritual base provides family members with strength and hope in times of adversity and teaches them how to have healthy relationships within the family unit and with others. It is also evident that sharing activities, as the things that all members of the family do together, reinforce and strengthen their togetherness and that if family members can be aware of what aggravates mentally ill family members by communicating well with them, that can bring harmony in families and ultimately limit relapse. Recommendations in this research are made for nursing education, nursing research and psychiatric nursing practice with guidelines for psychiatric nurses to empower families caring for mentally ill family members to use their strengths and contribute to limiting relapse. / MCur, North-West University, Potchefstroom Campus, 2014