Bakgrund: I Sverige uppskattas att närmare 38 000 flickor och kvinnor varit utsatta för någon typ av kvinnlig könsstympning. Av dem tros 7000 vara flickor under 18 år. Andelen flickor som befinner sig i riskzonen för könsstympning är oklar. Tidigare forskning visar att flickor i riskzonen är de vars mödrar är könsstympade samt familjens attityd till traditionen. Betydelse för att hamna i riskzon för det beror även på hur länge de bott i Sverige samt integrationen. Barnhälsovårdspersonal har till uppgift att främja hälsa på lika villkor genom att tidigt identifiera och initiera åtgärder vid problem i barns hälsa, utveckling och uppväxtmiljö. Samverkan mellan barnavårdscentral och socialtjänst genom utökat hembesöksprogram är ett arbetssätt som bygger på förtroende mellan personal och föräldrar. Ett ökat föräldrastöd och kortare vägar till hjälp hos socialtjänsten. Barnhälsovårdspersonalen som kommer att börja arbeta med ett utökat hembesöksprogram ska kunna känna sig trygga i att de kan möta barnfamiljer med flickor i riskzonen för könsstympning. Syfte: Syftet med studien var att undersöka barnhälsovårdspersonalens förhållningssätt i arbetet med flickor i riskzonen för könsstympning. Metod: En kvalitativ intervjustudie med åtta deltagare inom barnhälsovården. Urvalet var strategiskt och intervjuerna spelades in, transkriberades och analyserades enligt kvalitativ innehållsanalys. Resultat: Analysen resulterade i temat ojämlikt bemötande och påvisade att personalen inom barnhälsovården bemöter flickor i riskzonen för könsstympning olika. Resultatet visar att det finns olikheter i förhållningssättet med att bemöta flickor i riskzonen för könsstympning och även hur hälsovårdspersonalen inom barnhälsovården hanterar att det finns flickor i riskzonen för könsstympning. Deltagarna hade utvecklat olika strategier eller inga strategier alls för att hantera frågan. Slutsats: Det råder ett ojämlikt bemötande av flickor i riskzonen för könsstympning inom barnhälsovården och det behöver utvecklas en mer jämlik barnhälsovård i socioekonomiskt utsatta områden. En god samverkan innebär hållbarhet både på kort och lång sikt. / Background: In Sweden, it is estimated that nearly 38,000 girls and women have been exposed to some type of female genital mutilation. Of those, 7000 are believed to be girls under 18 years of age. The proportion of girls in risk zone is unclear. Previous research shows that girls at risk are those whose mothers are genital mutilated and how the family´s attitude to the tradition. Significance for ending in a risk zone depends on how long they lived in Sweden as well as integration. Child health care staff have an important role to promote health on equal terms by identifying and initiating early action on problems in children´s health, development and growth environment. The interaction between child health care and social services in expanded home visit programs means a way of providing increased resources. It is a way of working based on trust between personal and parents. Increased parental support and shorter ways to assist in social services. The staff in the child health care who will start this model should be able to feel conscious and confident that they can meet families with girls at risk of genital mutilation. Aim: The aim of the study was to investigate the attitude of the child health care staff in the work of girls at risk of genital mutilation. Method: A qualitative interview study with eight participants in child health care was done. The selection was strategic and the interviews were recorded, transcribed and analyzed by a qualitative content analysis. Results: The analysis resulted in the theme unequal treatment and shows that the child health care personnel treats girls at risk of genital mutilation differently. There are differences in the approach of responding to girls at risk of genital mutilation and also how child health care personnel handle there are girls at risk of genital mutilation. The participants had developed different strategies or no strategies at all to handle the issue. Conclusion: The results show different approaches to the work of girls at risk of genital mutilation in child health care and it reinforces the picture of the importance of a more equal child health care in socio-economically vulnerable areas. Good cooperation means sustainability in the short and long term.

In this study the focus is on Batho Pele (a Sotho translation for 'people first'), an initiative to get people that work in the public services to be service orientated and to strive for excellence towards continuous service delivery improvement (SA, 2004a:8). Batho Pele consist of a framework with two primary functions that apply to this study; service delivery to people as the customers (patients in this study) and the possibility to hold individual public servants (health care personnel in this study) accountable for poor service delivery. This, in fact, implies that poor performance lead to poor service delivery; thus, compliance with the Batho Pele principles plays a pivotal role to improve quality health care service delivery. The purpose of the study was to make recommendations to enhance the current compliance with the Batho Pele principles in a Primary Health Care (PHC) context that would positively improve quality care and patient satisfaction. A non–experimental, quantitative, descriptive study was undertaken within the philosophical framework of the Batho Pele principles as well as the Patients‘ Right Charter. All participants completed a structured questionnaire to determine the level of compliance with the Batho Pele principles as experienced by the patients and viewed by the health care personnel in a PHC context. The data collected, was analysed using descriptive statistics. Four PHC clinics were involved, situated at Umzinyathi District Health in the Kwazulu Natal (KZN) Province of South Africa. The study included two patient–population samples, based on convenience; the participants that visited the clinics (n=132) and the participants visited by the researcher at home (n=101). Fifty– six (n=56) health care personnel who voluntary agreed to participate in the study were an all–inclusive sample. The findings revealed that the patients in the study felt more secure to answer the questions on their experiences regarding compliances with the Batho Pele principles at home and this could be an important consideration when conducting patient satisfaction surveys. It was also clear that patients were more dissatisfied than health care personnel in most questions asked regarding their experience on the compliance with the Batho Pele principles in a PHC context. Recommendations were made in the light of what was contained in the study that can serve as a starting point to address identified shortcomings in nursing practice, nursing education and nursing research. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2011.

In this study the focus is on Batho Pele (a Sotho translation for 'people first'), an initiative to get people that work in the public services to be service orientated and to strive for excellence towards continuous service delivery improvement (SA, 2004a:8). Batho Pele consist of a framework with two primary functions that apply to this study; service delivery to people as the customers (patients in this study) and the possibility to hold individual public servants (health care personnel in this study) accountable for poor service delivery. This, in fact, implies that poor performance lead to poor service delivery; thus, compliance with the Batho Pele principles plays a pivotal role to improve quality health care service delivery. The purpose of the study was to make recommendations to enhance the current compliance with the Batho Pele principles in a Primary Health Care (PHC) context that would positively improve quality care and patient satisfaction. A non–experimental, quantitative, descriptive study was undertaken within the philosophical framework of the Batho Pele principles as well as the Patients‘ Right Charter. All participants completed a structured questionnaire to determine the level of compliance with the Batho Pele principles as experienced by the patients and viewed by the health care personnel in a PHC context. The data collected, was analysed using descriptive statistics. Four PHC clinics were involved, situated at Umzinyathi District Health in the Kwazulu Natal (KZN) Province of South Africa. The study included two patient–population samples, based on convenience; the participants that visited the clinics (n=132) and the participants visited by the researcher at home (n=101). Fifty– six (n=56) health care personnel who voluntary agreed to participate in the study were an all–inclusive sample. The findings revealed that the patients in the study felt more secure to answer the questions on their experiences regarding compliances with the Batho Pele principles at home and this could be an important consideration when conducting patient satisfaction surveys. It was also clear that patients were more dissatisfied than health care personnel in most questions asked regarding their experience on the compliance with the Batho Pele principles in a PHC context. Recommendations were made in the light of what was contained in the study that can serve as a starting point to address identified shortcomings in nursing practice, nursing education and nursing research. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2011.

Gender disparity in healthcare sector leadership positions is a major problem among female healthcare professionals in Southern Ethiopia. This study explored gender disparities among healthcare professionals in healthcare sector leadership positions. The findings would be used to develop guidelines to reduce gender disparities in healthcare leadership in healthcare sectors to a minimum in Ethiopia. This study used exploratory and descriptive cross-sectional research design incorporating a mixed methods research approach to collect both quantitative and qualitative data simultaneously which were analyzed during the same phase of the research process. The quantitative survey data was collected using piloted structured questionnaire while qualitative data was collected using semi-structured interview guide containing open questions. Quantitative data was collected from a random sample of 414 healthcare professionals and qualitative data from a purposive sample of 21 healthcare professionals from seven districts having the experiences of gender disparity in healthcare leadership positions. Quantitative data had a compliance rate of 98% and it was entered into EpiData version 3.1 and exported to SPSS (version 24) for further analysis, and the qualitative data was coded and analyzed manually into thematic content. Quantitative findings of the study revealed that only 26% (n=108) of the participants reported that representation of women in healthcare sector leadership positions in the past few years has been increased. The majority of leadership positions assumed by study participants were at department head level while only 1.3 % were on chief excutive officers and 2.3% medical director positions respectively. Of these none was a female and 67%, n=264 of the participants do not have leadership role in a health service facility. Study participants having bachelor degree level of education were 2.3 times more likely to be represented in healthcare sector leadership positions than those participants having master’s degree and diploma [AOR=2.3, (95% CI: 1.289, 4.252)]. Challenges experienced by women health professionals regarding gender disparity in leadership positions in health service facility included family responsibilities, lack of support, lack of self-esteem or self-confidence, lack of career advancement, and cultural bias. The conclusions derived from the study was that women need all the opportunities, encouragement and support to allow them access to and success in healthcare sector leadership positions through informal and formal leadership training. / Health Studies / D. Litt et Phil (Health Studies)

Bakgrund: Transpersoner är mer utsatta för kränkningar, trakasserier, våld och hot om våld än resterande befolkning, vilket påverkar transpersoners hälsa negativt. Trots att behov av hjälp finns undviker transpersoner att uppsöka vård, på grund av en rädsla att bli förminskade eller förnekade av vårdpersonal. Transpersoner förlorar förtroendet när vårdpersonal uppvisar kunskapsbrist. Genom att identifiera faktorer som påverkar transpersoners upplevelser av vården, möjliggörs goda förutsättningarför ökad kunskap. Syfte: Att undersöka vilka faktorer som påverkar transpersoners upplevelser av hälso- och sjukvården. Metod: En allmän litteraturstudie med induktiv ansats. Sju vetenskapliga artiklar från tre databaser granskades, och sammanställdes till fyra kategorier. Resultat: Transpersoners upplevelser av hälso- och sjukvården påverkas till stor del av olika faktorer. En könsbekräftande miljö samt ett bra bemötande av vårdpersonalen, medför känslor av trygghet hos transpersoner. En god vårdrelation skapar förtroende hos transpersoner gentemot vårdpersonalen, samtidigt som vårdpersonalens kunskapsbrist utgör ett hinder för adekvat vård. Konklusion: Vårdpersonal bör bemöta alla människor lika med acceptans, omsorg och samhörighet. Sjuksköterskeutbildningen behöver inkludera kunskap kring omvårdnad av transpersoner. Ökad kunskap om faktorer som påverkar transpersoners upplevelser av hälso- och sjukvården, bidrar till att vårdpersonal kan förbättra mötet med transpersoner och ge en jämlik och god vård till alla patienter. / Background: Transgender people are more exposed to violations, haressment,violence and threats than the rest of the population, which negatively affects transgender people´s health. Despite the need for help, transgender people tend to avoid seeking healthcare, due to a fear of being diminished or denied by healthcare professionals. Transgender peoples´ trust disappears when healthcare professionals show a lack of knowledge. By identifying factors that affect transgender peoples’ experiences of care, good conditions are made possible for increased gender awareness. Aim: To investigate which factors influence transgender peoples’ experiences of health care. Method: A general litterature study with an inductive approach. Seven articles from three databases were reviewed and compiled into fourcategories. Results: Transgender peoples’ experiences of healthcare are largely influences by various factors. A gender- affirming environvent, as well as good treatment by healthcare professionals, brings feelings of security to transgeder people. A good care relationship creates trust in trans people towards the healthcare professionals, while at the same time the healthcare professionals’ lack of knowledge constitutes an obstacle to adequate care. Conclusion: Healthcare professionals should treat all people equally with acceptance, care and belonging. Nursing education needs to include knowledge about caring for transgender people. Increased knowledge about factors that affect transgender peoples´experiences of health care, contributes to healthcare professionals being able to improve the meeting with transgender people and provide equal and good care to all patients.

This thesis focuses on the protection of the patient’s privacy in health care in Sweden. It is crucially important that the patient has confidence in the health care and that patient data are kept secret from other persons and authorities. A patient who is unsure about secrecy and confidentiality may choose not to provide data that could prove necessary for health care personnel to arrive at an accurate diagnosis. Some individuals might even avoid seeking medical help from fear that data may be spread to outsiders. Inadequate protection of sensitive data may lead to the confidence of citizens in health care eventually eroding or vanishing completely. Protection of patient privacy is thus of fundamental importance in this area. In the area of health care, the intention of the legislator is that the regulations regarding secrecy in public health care and confidentiality in private health care will guarantee protection of patient privacy. Secrecy in public health care is regulated mainly in Chapter 25, Section 1 of the Swedish Public Access to Information and Secrecy Act (2009:400). In private health care, confidentiality is regulated mainly in Chapter 6, Section 12, first paragraph, and Section 16 of the Swedish Act on Patient Safety (2010:659). The overall purpose of the thesis is to examine and analyse the legislator’s intentions and the juridical construction regarding the rules of secrecy and confidentiality, from the perspective of patient privacy. The starting point of the thesis is that the patient’s privacy should be strongly protected. One of the main conclusions is that the legal construction cannot be considered to be in accordance with the legislator’s intention that the regulation of patient privacy protection should constitute a strong protection for the patient’s privacy, be comprehensible, clear and easy to apply for health care personnel, as well as being the same in both public and private health care.

Thesis (MBA)--University of Stellenbosch, 2011. / Healthcare systems of the world’s poorer nations have been heavily impacted by economic globalisation. This has resulted in a steady deterioration of working conditions, resulted in less job security and has led to an increase in the spread of communicable diseases in developing countries such as South Africa. It is factors such as these, against the backdrop of a global recession, that have contributed to the escalation in global healthcare costs which has itself augmented the strain on already strained hospital resources in developing economies (Issues paper: Economic Globalisation, 2009). The current workplace faces complicated challenges which extend beyond the effects of the global recession. One of these challenges is the task of managing the diversity of the modern day workforce. This includes differences in gender, race, religion, culture, language, physical and mental ability, sexual orientation as well as generational differences. As a result, organisations that choose to exploit these differences are able to leverage a competitive advantage from them. This ability is however determined by the flexibility of organisations’ policies and practices. Furthermore, adapting an organisation’s human resource policies and practices pertaining to attracting, retaining, developing, promoting and managing a generational diverse workforce is only possible once these cohorts have been clearly identified, analysed and understood (Manion, 2009). Nurses are the pillar of healthcare systems throughout the world. In South Africa, however, the high staff turnover of nurses compared to the relatively small number of new recruits is of great concern due to its impact on the South African government’s capacity to provide a healthcare model of sustainable service delivery (Mokoka, 2007). The reality of the decline in the number of newly qualified nurses was clearly evident in the results of this study. Twenty-eight percent of the current community service nurses had previously considered leaving the profession, eight percent reported that they were considering leaving the profession within the next year and 20 percent intended leaving the public health sector after completing community service. The purpose of this qualitative study was to determine factors that preclude better remuneration that would influence community service nurses’ decision to remain employed in the public health sector. According to the Western Cape Nursing directorate, 270 nurses were registered to complete community service in the Western Cape in 2010. The 25 registered nurses who were scheduled to complete community service at Groote Schuur Hospital at the end of 2010 constituted the study sample. A self-administered questionnaire was used as the instrument for data collection from this fixed, convenient sample. Confidentiality of the participants was assured throughout the study and findings were reported as combined facts and figures using histograms. The majority of the participants were between the age of 20 and 25 years (48%). Furthermore, 88 percent of the participants were below the age of 35 years, largely representative of Generation X and the Millennials, Generation Y. The results of this study suggested an extremely complex interplay between intrinsic and extrinsic motivators, in influencing the decision of whether or not to remain employed in the public health sector. It was further evident that most of the factors that were rated to be of high importance were strongly self-centred, largely geared at personal reward and recognition. This finding is in clear agreement with literature published by Manion (2009) who supports the thinking that generations representative of Generation X and Y have a strong need for personal achievement and reward. Eighty percent of participants indicated a dire need for hospital management to recognise and manage generational diversity in the current workforce as this presented a daily challenge in the workplace. It was perceived that fundamental differences in needs, work ethic and values exist between Generations X and Y, compared to those of nurse and hospital managers who were representative of Baby Boomers. Consequently, there appeared to be a mismatch in the expectations and opportunities presented in the current workplace among the three generations. These findings merit further discussion on whether the permanent multi-disciplinary team at hospitals understand the influential role that they have on the complex task of retaining community service nurses in the public health service. Furthermore, 92 percent of community service nurses highlighted the need for mandatory orientation and induction programmes in each ward prior to commencing duty. This in itself was identified as a huge cause for anxiety and discord. In conclusion, even though this study was designed to establish factors that preclude better remuneration which could influence the decision of community service nurses to remain employed in the public health sector, it found that more than half the participants of this study recommended that receiving a more competitive salary was still an important issue for government to prioritise. However, it did not appear to be the overshadowing theme of dissatisfaction amongst community service nurses.

Bakgrund: Samsjuklighet är vanligt förekommande bland personer med psykisk ohälsa. Samtidigt finns indikationer på att patienter med vanligt förekommande psykiatriska diagnoser riskerar att inte få fullgod behandling av sina somatiska sjukdomstillstånd. Bristande vårdkvalité och tillgänglighet är två orsaker som anses vara bidragande till förlust av levnadsår hos denna patientgrupp. Patienter med psykisk ohälsa har rätt till en vård utan diskriminering, men forskningen visar att det kan förekomma negativa attityder och stigmatisering mot dessa patienter från vårdpersonal. Syfte: Syftet med litteraturöversikten var att belysa upplevelser och erfarenheter hos patienter med psykisk ohälsa av bemötande från vårdpersonal i den somatiska vården. Metod: Litteraturöversikt med 13 vetenskapliga artiklar från sex olika länder hämtades från Cinahl och PsycINFO. Artiklarna analyserades enligt Friberg. Resultat: Fyra huvudteman identifierades: Erfarenheter av att bli marginaliserad, Erfarenheter av bra bemötande, Erfarenheter av att vården inte räcker till och Konsekvenser av negativt bemötande. Diskussion: Med Orlandos teori om det dynamiska förhållandet mellan sjuksköterska och patient som teoretisk utgångspunkt diskuteras resultatet i relation till Orlandos nyckelbegrepp: evidensbaserad vård, dialog och reflektion. Behov av ytterligare kompetens hos vårdpersonal i att vårda patienter med psykisk ohälsa var en sak som lyftes. / Background: Somatic and psychiatric comorbidity are frequent in patients with mental illness. There is a risk that patients with common mental disorders don’t get adequate treatment for their somatic health problems. Lack of care quality and availability to somatic health care are issues considered contributory to years of life lost to these patients. Patients with mental disorders have the right to receive care without discrimination, though research indicates that negative attitudes and discrimination by health-care personnel towards these patients may occur. Aim: The aim of this literature review was to reveal how patients with mental illness experience the encounter with health care personnel in somatic care. Method: A literature review with 13 original research articles from six different countries was retrieved from the databases Cinahl and PsycINFO. The studies were analyzed based on Fribergs method. Results: Four main themes were crystallized: Experiences of being marginalized, Positive experiences of health care, Experiences of health care not being good enough and Consequences of negative attitudes. Discussion: The article result was discussed related to Orlando’s nursing process The dynamic nurse-patient relationship and her key concepts: evidence-based nursing, communication, dialogue and reflection. The need for additional   expertise in caring for patients with mental illness was one of the points raised.

Background: In paediatrics, the limited documentation to guide medication, the lack of suitable dosage forms, and the continuous development in childhood present a scenario where safety of medication is a particular challenge. Aim: To explore reported adverse drug reactions (ADRs) and the challenges in prescribing and administering medicines in paediatrics, in order to identify and suggest areas needing international surveillance within medication safety and improvement in the clinical setting. Methods: Four exploratory studies were conducted. Worldwide reporting of suspected ADRs (individual case safety reports, ICSR) with ages 0-17 years were examined overall. Twenty published case reports and ICSRs for adolescents, who developed a rare and incompletely documented ADR (rhabdomyolysis) during antipsychotic medicine use, were analysed in-depth. Prescribed doses of anti-inflammatory medicines were studied in a UK electronic health record database. Transcribed focus group interviews with 20 registered nurses from four paediatric wards in Sweden were analysed for factors that may promote or hinder safe medication practices. Descriptive statistics, multiple regression, and content analyses were used. Results: Although, skin reactions and anti-infective medicines were most frequently reported, and more reported in paediatric patients than in adults, medication errors and adverse reactions related to psychostimulant medicines were reported with increased frequency during 2005 to February 2010. The in-depth case analysis emphasised the need for increased vigilance following changes in patients’ medicine regimens, and indicated that ICSRs could contribute with clinically valuable information. Prescribed dose variations were associated with type of dosage form. Tablets and capsules were prescribed with a higher dose than liquid dosage forms. Six themes emerged from the interviews: preparation and administration was complex; medication errors caused considerable psychological burden; support from nurse colleagues was highly valued; unfamiliar medication was challenging; clear dose instructions were important; nurses handling medications needed to be accorded higher priority. Conclusions: Age-specific screening of ICSRs and the use of ICSRs to enhance knowledge of ADRs and medication errors need to be developed. Access to age-appropriate dosage forms is important when prescribing medicines to children. To improve medication safety practices in paediatric care, interdisciplinary collaborations across hospitals on national or even global levels are needed.

Text in Afrikaans / Health care has typical challenges and stress factors as employees deal with people in a very personal manner. This exclusively client-centred environment requires special skills from employees if they wish to perform well. In addition to excellent interpersonal and stress management skills, they need to be able to handle their own and patients' emotions well. These skills can be referred to as emotional intelligence competencies. Emotional intelligence is a relatively new concept with many possibilities if applied correctly. This study involves 114 employees, their colleagues and supervisors in two health-care organisations. The 360° Emotional Competency Profiler was used together with the internal performance evaluation scores, and statistical techniques such as t-tests and discriminant analysis were utilized. It was found that certain emotional intelligence dimensions and work performance are related to a certain extent. However, other factors also need to be considered if one wants to make predictions in this regard. / Die gesondheidsorgomgewing het unieke uitdagings en stresfaktore omdat werknemers op 'n baie persoonlike vlak met mense werk. Die uitsluitlik klientgesentreerde omgewing verg spesiale vaardighede indien werknemers goed wil presteer. Buiten uitstekende interpersoonlike- en streshanteringsvaardighede, moet hulle ook in staat wees om hulle eie en huile pasiente se gevoelens te kan hanteer. Hierdie vaardighede kan na verwys word as emosionele intelligensievaardighede. Emosionele intelligensie is 'n relatief nuwe konsep wat baie toepassingsmoontlikhede het indien dit reg aangewend word. Hierdie studie betrek 114 beskikbare werknemers en hulle kollegas en toesighouers in twee gesondheidsorgorganisasies. Die 360° Emotional Competency Profiler is saam met die interne prestasie-beoordelingstellings gebruik en daar is gebruik gemaak van statistiese tegnieke soos f-toetse en diskriminantontleding. Daar is bevind dat sekere emosionele intelligensie dimensies in 'n sekere mate 'n onderlinge verband toon met werksprestasie. Ander faktore moet egter ook in ag geneem word indien mens 'n voorspelling in hierdie verband wil maak. / Industrial and Organisational Psychology / MCOM (Industrial and Organisational Psychology)