The aim of this thesis was to identify important aspects of surgical nursing care, designing strategic and clinical quality indicators in postoperative pain management, investigate content validity, develop and evaluate psychometric properties of an instrument to measure the indicators, test the applicability of the instrument and investigate patient and nurse assessment. To identify the important aspects of nursing care which might impact on quality of care in surgical wards, it was conducted 4 focus group interviews with clinical nurses (n=20). A tentative model with 15 categories in 2 dimensions, elements of performance and prerequisites, emerged from the data analysis. The categories were, e.g. detecting and acting on signs and symptoms, informing and educating, promoting relationships, responsibility and attitudes. The model was used as a foundation for developing indicators in postoperative pain management, one in each category, each supported by a literature review. To assess the content validity of the indicators, a questionnaire was compiled and sent to registered nurses with a special interest in pain (n=210) and to a random sample of clinical nurses working in surgical wards (n=321). The groups assessed the indicators as essential for achieving high quality, realistic to carry out and possible for nurses to influence management. The first group validated 14 of the 15 indicators and the second group validated 12 as “major” factors in terms of being essential to achieve high quality of care. The remaining factors were classified as “supportive”. No indicator was discarded. To measure the indicators, an instrument was developed and psychometric properties were evaluated. The indicators were converted to statements suitable for a patient questionnaire and were scored on a 5-point scale with higher values indicating higher quality of care. Patients (n=198) answered the questionnaire on their second postoperative day. The inter-item and item-total correlation coefficients were in a satisfactory range, and Cronbach’s coefficient alpha (0.84) supported internal consistency reliability. Four sub-scales, entitled communication, action, trust and environment emerged from the factor analysis with a total variance of 61.4%. The total scale correlated (rs=0.53) with the single item pain-relief-satisfaction question. The patients who reported more pain than expected scored lower on the total scale and the patients who received epidural analgesia reported higher scores on the total scale. A nurse questionnaire, similar to the patient questionnaire, was compiled. The responsible nurse at the time (n=63) answered 196 questionnaires paired with the individual patient. The new instrument appeared to be useful in identifying important areas for improvement both from the patients’ and nurses’ perspectives, based on the number of disagreements (1 and 2). Differences were found among departments. The patients’ assessments on the environment sub-scale and the overall satisfaction question were higher than the nurses’ assessments. The findings suggest initial support for the instrument as a means to measure the quality of nursing care in postoperative pain management. Key words: quality indicators; health care, pain; postoperative, focus groups, psychometrics, questionnaires, nursing care. / On the day of the public defence of the doctoral thesis the status of the articles III was: Accepted; article IV and V was: Accepted for publishing.

The concept of experiences may not be all that revolutionary or new, however, the notion of an economy where experiences make up the core of all businesses is. This suggestion was made by Pine and Gilmore in 1999 in their bestseller “The Experience Economy”, and since then, the concept has received a lot of positive attention. Critics of the authors’ proposal still remain few in number, and there is a lack of research re-garding experiences and consumers. As the authors of this thesis we posed ourselves positive to the Experience Economy in general, but also a bit hesitant to the idea of companies offering experiences in all consumer contexts. Due to the lack of research regarding the demand side, we set out to explore the phenomenon of the Experience Economy from the perception of consumers. By doing so we hoped to find whether or not a foundation for Pine and Gilmore’s (1999) idea exists. In order to explore consumers’ perceptions of the Experience Economy, we focused on what is at the core of the concept – experiences. A qualitative research approach was decided upon, and three focus group interviews were conducted. The focus groups were made up of young consumers, parents of small children, and middle aged consumers. The empirical findings indicate that a foundation for the claim that the Experience Economy is emerging does exist, at least to the extent that no substantial barriers have been identified. However, we believe that the notion of an experience-based economy is only to be discussed if the concept is somewhat widened in its claims. That is, our summation of the consumers’ perceptions of the Experience Economy suggests that experiences need to be viewed as existing along a spectrum, ranging from a negative to a positive extreme. Rather than just being at the positive extreme, as indicated by scholars, we believe that staged experiences in the Experience Econ-omy will range from the spectrum’s neutral centre to only on rare occasions touch upon the extraordinaire.

Being customer‐focused is often considered to be a key success factor inproduct‐ or service development. This kind of approach may comprise manythings in practice, such as formal or informal methods and activities that arecarried out to identify and meet, or preferably exceed, customer needs andexpectations. The overall purpose of this thesis is to contribute to a greaterknowledge about the use and function of methods, activities and tools regardingcustomer‐focused product development in the outdoor industry.The thesis is based on three papers, all related to customer‐focused productdevelopment within the outdoor industry. Two empirical studies have beenconducted. In the first one, the outdoor companies’ own experiences of customerinvolvement in product development are examined. In the second study, the useand function of environmental labels as drivers of attractive quality within theoutdoor industry are explored.A new methodology for customer‐focused product development is alsopresented. It is aimed to be used as a hands‐on support for designing for thesatisfaction of customer needs at different levels in practice, especially those thathave been found to be important in the creation of attractive quality and customerloyalty.

Background: Research focusing on Food Distribution (FD) from various professionals’ and organisational perspectivesare lacking. The aim of this study was therefore to explore various professionals’ experiences of involvement in FD inorder to get comprehensive understanding of the organisation, responsibilities and roles. Methods: This qualitative study is a part of a larger project with an action research approach focusing on FD in themunicipal home service and care for home-living elderly persons in a municipality in southern Sweden. The data wascollected through participatory observations (n=90 occasions and in total 480 hours), repeated focus group interviews (n =4) with different professionals (n =10) involved in the FD process and one individual interview. The material was analysedby qualitative manifest and latent content analysis. Results: The study indicates that Food Distribution is a fragmentary intervention where a comprehensive perspective andclear roles of responsibility are lacking. The FD organisation seemed to be strictly divided and limited by constraintsregarding time and money. The fragmented organisation led partly to staff only taking responsibility for their part of thechain and no one having the full picture of and responsibility for the FD process, but also to some professionals takingmore responsibility than they were supposed to. Conclusions: The aim of the study was met by using an action research approach. The study was however limited by thatno home help officers were represented. The FD appeared as an extremely complex chain of different but connectedactivities. It is not merely the distribution of a product, i.e. the meal box. The fragmentation of FD means that staff onlytakes responsibility for their part of the chain, and that no one has the full picture of or responsibility for the FD process.Consequently, there is a need for an outline of responsibilities. The findings have implications for nursing, gerontology,and in the care for the elderly. / <p><strong></strong> </p>

Background: An emergency department (ED) should offer timely care for acutely ill or injured persons that require the attention of specialized nurses and physicians. This study was aimed at exploring what is actually going on at an ED. Methods: Qualitative data was collected 2009 to 2011 at one Swedish ED (ED1) with 53.000 yearly visits serving a population of 251.000. Constant comparative analysis according to classic grounded theory was applied to both focus group interviews with ED1 staff, participant observation data, and literature data. Quantitative data from ED1 and two other Swedish EDs were later analyzed and compared with the qualitative data. Results: The main driver of the ED staff in this study was to reduce non-acceptable waiting. Signs of non-acceptable waiting are physical densification, contact seeking, and the emergence of critical situations. The staff reacts with frustration, shame, and eventually resignation when they cannot reduce non-acceptable waiting. Waiting management resolves the problems and is done either by reducing actual waiting time by increasing throughput of patient flow through structure pushing and shuffling around patients, or by changing the experience of waiting by calming patients and feinting maneuvers to cover up. Conclusion: To manage non-acceptable waiting is a driving force behind much of the staff behavior at an ED. Waiting management is done either by increasing throughput of patient flow or by changing the waiting experience.

Introduction: Gendered practices of working life create gender inequalities through horizontal and vertical gender segregation in work, which may lead to inequalities in health between women and men. Gender equality could therefore be a key element of health equity in working life. Our aim was to analyze what gender (in) equality means for the employees at a woman-dominated workplace and discuss possible implications for health experiences. Methods: All caregiving staff at two workplaces in elder care within a municipality in the north of Sweden were invited to participate in the study. Forty-five employees participated, 38 women and 7 men. Seven focus group discussions were performed and led by a moderator. Qualitative content analysis was used to analyze the focus groups. Results: We identified two themes. "Advocating gender equality in principle" showed how gender (in) equality was seen as a structural issue not connected to the individual health experiences. "Justifying inequality with individualism" showed how the caregivers focused on personalities and interests as a justification of gender inequalities in work division. The justification of gender inequality resulted in a gendered work division which may be related to health inequalities between women and men. Gender inequalities in work division were primarily understood in terms of personality and interests and not in terms of gender. Conclusion: The health experience of the participants was affected by gender (in) equality in terms of a gendered work division. However, the participants did not see the gendered work division as a gender equality issue. Gender perspectives are needed to improve the health of the employees at the workplaces through shifting from individual to structural solutions. A healthy-setting approach considering gender relations is needed to achieve gender equality and fairness in health status between women and men.

BACKGROUND:The teenage years are the years when adolescents seek their identity, and part of this involves experimenting with tobacco. The use of tobacco as such, and norms among their friends, is more important to the adolescents than the norms of parents when it comes to using tobacco or not. The aim was to explore the significance of using snus for adolescents, and attitudes to snus, as well as the reasons why they began using snus and what maintained and facilitated the use of snus.METHODS:Adolescents who use snus were interviewed in focus groups. The material was analysed using content analysis.RESULTS:Four groups of boys and one group of girls were interviewed, a total of 27 students from the upper secondary vocational program. Three themes related to the students' opinions on and experiences of using snus were found: Circumstances pertaining to snus debut indicate what makes them start using snus. Upholding, which focuses on the problem of becoming addicted and development of identity, and approach, where the adolescents reflect on their snus habits in relation to those around them. A number of factors were described as relevant to behaviour and norm building for the development into becoming a snus user. Attitudes and actions from adults and friends as well as - for the boys - development of an identity as a man and a craftsman influenced behaviour.CONCLUSIONS:The results showed that development of identity was of major importance when adolescents start using snus. The adolescents were initially unable to interpret the early symptoms of abstinence problems, but subsequently became well aware of being addicted. Once they were stuck in addiction and in the creation of an image and identity, it was difficult to stop using snus. These factors are important when considering interventions of normative changes and tobacco prevention in schools as well as among parents.

Avatime, a Kwa language of Ghana, has an additive particle tsyɛ that at first sight looks similar to additive particles such as too and also in English. However, on closer inspection, the Avatime particle behaves differently. Contrary to what is usually claimed about additive particles, tsyɛ does not only associate with focused elements. Moreover, unlike its English equivalents, tsyɛ does not come with a requirement of identity between the expressed proposition and an alternative. Instead, it indicates that the proposition it occurs in is similar to or compatible with a presupposed alternative proposition.

The paper discusses the distribution and meaning of the additive particle -m@s in Ishkashimi. -m@s receives different semantic associations while staying in the same syntactic position. Thus, structurally combined with an object, it can semantically associate with the focused object or with the whole focused VP; similarly, combined with the subject it can semantically associate with the focused subject and with the whole focused sentence.

Objective: The study compared how specific affect focuses in early stages of treatment predict outcome (SCL-90) for specific cluster C personality disorders. Method: The sample consisted of patients with cluster C personality disorders from a randomized controlled trial comparing 40-sessions of short-term dynamic psychotherapy and cognitive psychotherapy. Thirty-one patients had an avoidant personality disorder (AVPD), 17 patients had an obsessive compulsive personality disorder (OCPD) and 10 had a dependent personality disorder (DPD). The Global Severity Index (GSI) of the SCL-90 was used as the outcome measure and the Achievement of Therapeutic Objective Scale (ATOS) was used as a process measure to rate patients affects in an early session (session 1 and 6). Results: The results indicated that focus on closeness and anger predicted outcome for AVPD, focus on positive feelings for self predicted outcome for OCPD and focus on grief predicted outcome for DPD. Conclusion: Specific affect focuses in early stages of treatment is significant for various cluster C personality disorders to predict outcome.