Trauma-informed care (TIC) is an approach to service delivery based on the understanding of the prevalence of psychological trauma among service users, knowledge about the impact trauma has on engagement to services, and recognition that service settings can be re-traumatizing. For more than a decade, momentum has been building on this topic. Practitioners are pursuing the knowledge and skills needed to implement trauma-informed service delivery, while organizations are building infrastructure and processes aimed at supporting this approach. Disciplines across many human service sectors are eager to incorporate TIC into policy and practice. Despite this enthusiasm, implementation efforts are slow. Acquiring foundational knowledge about TIC has typically been recommended as a first step when implementing a trauma-informed approach. However, slow progress in implementation suggests knowledge may not be enough. This study investigated the individual characteristics that impact a commitment to TIC, with specific attention to the relationship between foundational knowledge about trauma-informed care and commitment to TIC. Other variables of interest included perceived principal support, TIC self-efficacy, beliefs about trauma and its impact, and organizational strain. Survey data were collected from 118 participants working in mental health, public health, and early childhood. Results from structural equation modeling suggest that foundational knowledge predicts affective commitment to TIC both directly and with the partially mediated paths through principal support, TIC self-efficacy, and beliefs about trauma. Organizational strain does not moderate these effects. However, group differences based on high and low levels of perceived organizational strain were observed and discussed. These findings add to the growing literature on TIC and should be considered as organizations strive to implement TIC.

Bakgrund: Våld mot kvinnor är ett globalt hälsoproblem, 35% av samtliga kvinnor i världen har någon gång blivit utsatta för våld. Sjuksköterskans ansvar syftar till att identifiera behov och erbjuda god omvårdnad till kvinnan utsatt för våld utifrån rådande situation. En bristande sjukvård leder till sjuksköterskor som tvivlar på sin förmåga och patienter som känner sig otrygga till att avslöja våldet. Identifieras inte kvinnans utsatthet föreligger det en risk att hon kvarblir i en osund relation och i värsta fall dör till följd av våldet. Syfte: Att beskriva hindrande och möjliggörande faktorer för att identifiera kvinnor som utsatts för våld i nära relationer. Metod: En allmän litteraturstudie utifrån tio artiklar med både kvantitativ och kvalitativ ansats. Huvudresultat: Identifierade utmaningar var vårdpersonalens bristande kunskap, känslor och attityder samt organisatoriska brister. Vikten av identifiering och den betydelsefulla vårdrelationen identifierades som möjligheter till upptäckten av kvinnor utsatta för våld. Både utmaningar och möjligheter hade anknytningar till sjuksköterskans kunskap, attityd, identifiering, bemötande och ansvar. Slutsats: Slutsatsen tyder på att bristfällig kunskap, organisatoriska brister såväl som känslor och attityder hos vårdpersonal står till grund för en del svårigheter såsom att inte veta hur de ska förhålla sig, inte veta var de ska vända sig och obehagskänslor. Bättre identifieringsstrategier och en betydelsefull vårdrelation visade påverka sjuksköterskans förhållningssätt till det bättre vilket kunde leda till fler avslöjanden från kvinnor. / Background: Violence against women is a global health problem, of which 35% of all women in the world sometime during their lifetime has experienced. The nurse has a significant part in the encounter with women exposed to violence due to the nurses responsability of identification and providing of a tailor-made nursing. An inadequate healthcare leads to nurses who discredit themselves and patients who feel unsafe to disclose the violence. If the nurse doesn’t identify battered women there is a risk that she stays in the abusing relationship and in worst case, dies. Aim: Was to describe obstructive and enabling factors for identifying women who were exposed to domestic violence. Method: A litterature study was applied based on ten articles that were of both quantitative and qualitative approach. Results: Identified challenges were the lack of knowledge, feelings and attitudes of healthcare professionals and organizational deficiencies. The importance of identification and the important care relationship were identified as opportunities for the discovery of women subjected to violence. Both challenges and opportunities had links to the nurse's knowledge, attitude, identification, treatment and responsibility. Conclusion: The conclusion suggests that insufficient knowledge is the basis for both organizational deficiencies but also feelings and attitudes among healthcare personnel, this was also the area that was most in need of development. Better identification strategies and a meaningful relationship to the patients turned out having positive effects on nurses approach, which could lead to more disclosures from women.

This study was inspired by the desire to understand the experience of mental health clinicians coping with work related stress in treating traumatized children. In studying this experience, heuristic design and methodology was followed. The findings of this study are based on interviews of 3 Caucasian, female clinicians, a 49-year-old art therapist with eight years experience, a 61-year-old licensed clinical social worker with 34 years of postgraduate experience, and a 44-year-old licensed clinical social worker with 21 years of experience. Mental health practitioners, clinical supervisors and consultants as well as professionals in counselor education benefit from the findings of this study that extends knowledge of effective coping with work related stress in treating traumatized children. Participants in this study coped by using the following core characteristics the most often: seeking emotional and instrumental support from others, maintaining balance in work and private life, staying spiritually oriented, participating in leisure activities, focusing on health and using cognitive restructuring techniques. The least mentioned was the use of humor. Four themes permeated the experience of these clinicians: (1) Maintaining Balance: Coping included maintaining a balance in work and private life; (2) Healthy Personal Identity: Coping successfully meant keeping the career as work and not a definition of the self; (3) Clear Role Definition: Coping to continue the work included increased focus on professional and personal boundaries and the role of the clinician; (4) Realistic Control: Successful coping included differentiating between what can and can't be controlled. This study also found that part of coping with work-related stress meant moving from the public sector into private enterprise. In private practice, participants found that coping with stress improved with the decrease of high client caseload requirements and the ability to screen potential clientele for the purpose of creating a balance in treatment issues. Overall, this study found that the experience of coping successfully with work-related stress had a great deal to do with increased professional autonomy. / Graduation date: 2003

The overall aim of the present thesis was to investigate experiences of living with multidrug-resistant bacteria (MDRB), using methicillin-resistant Staphylococcus aureus (MRSA) colonization as an illustration, and to develop and validate a tool to describe healthcare personnel’s attitudes towards patients with MDRB. A further objective was to study MRSA-colonized persons’ and healthcare personnel’s experiences of patient-professional interactions and responsibilities for infection prevention. Four empirical studies were conducted. A total of 18 MRSA-colonized persons and 20 healthcare personnel were interviewed regarding their experiences, and a total of 726 RNs responded the MDRB Attitude Questionnaire. The findings revealed the difficulties associated with living with MRSA colonization, which was described as something uncertain, and as an indefinable threat that has to be managed in both everyday life and in contacts with healthcare. Interactions with healthcare personnel were described as unprofessional owing to personnel’s inappropriate behaviour and insufficient information provision. According to the personnel, achieving adequate patient-professional interactions required having knowledge and experiences of MRSA. They also experienced difficulties in providing tailored information to patients. The MRSA-colonized persons described their unwanted responsibility to inform healthcare personnel about the colonization, but also felt responsible for limiting the spread of infection to others. Furthermore, responsibility for infection control was regarded as shared between healthcare personnel and patients. The personnel described such responsibility as a natural part of their daily work, although it was not always easy to adhere to hygiene precautions. The MRSA-colonized persons felt that healthcare personnel have insufficient knowledge of the bacteria and of hygiene precautions. The MDRB Attitude Questionnaire showed that registered nurses do have knowledge deficiencies. The MDRB Attitude Questionnaire has adequate psychometric properties. In conclusion, MRSA colonization constitutes a psychological strain for carriers, and interactions with healthcare personnel resulted in feelings of stigmatization. The present thesis indicates that there is a need to improve healthcare personnel’s knowledge, behaviour and emotional response in relation to patients with MDRB, in order to ensure patient safety and address patients’ needs. The heads of department is responsible for such improvements, and the MDRB Attitude Questionnaire is useful in identifying areas in need for improvement.

This thesis presents a challenge to policy initiatives that presume that patient-centered care will reduce racial disparities in health. Data from the Medical Expenditure Panel Survey were used to test patient assessment of provider behavior defined as patient-centered care according to the National Health Disparities Report of the Agency for Healthcare Research and Quality of the Department of Health and Human Services. Results indicated patient-centered care improves self-rated health status, but blacks still report worse health status than whites experiencing comparable patient-centered care. Further, black-white differences in patient-centered care had no affect on health status. Rival theories of black-white differences in health, including social class and health literacy, provided better explanations of disparities than assessment of provider behaviors. These findings suggest that policies designed to financially incentivize patient-centered care practices by providers should be considered with caution. While patient-centered care is better quality care, financial incentives could have a negative effect on minority health if providers are deterred from practices that serve disproportionate numbers of poor and less literate patients and their families. Measurement of the concept of patient-centered care in future health disparities research was also discussed.

Diss. (sammanfattning) Umeå : Umeå universitet, 2009. / Härtill 5 uppsatser.

The study was to investigate the effectiveness of Sociocultural Competency Training (SCCT) as an intervention in enhancing self-efficacy among trainees in the health care profession. The purposes of the study were threefold: (a) to evaluate the effectiveness of the training in enhancing the trainees' self-efficacy and behavioural performance; (b) to examine their personal experiences in the learning ofthe sociocultural competencies, and (c) to identify the factors that contribute to effective outcomes. A sample of 84 participants in the Health Sciences program at the Vancouver Community College was recruited. There were 26 local born Canadians and 32 immigrants in the experimental group, whereas 11 local born Canadians and 15 immigrants were in the control group. Experimental group participants took part in an 18- hour training over a 6-week period as part of their regular Human Relations Skills course curriculum. The control group also took the same training course after post-test data collection. This study used both quantitative and qualitative methods. Self-efficacy and behavioural performance were assessed quantitatively by the results from the General Self-Efficacy Scale (GSE), Situational Social Avoidance Scale (SSA), Social Self-Efficacy Scale (SSE), and Interpersonal Skills Checklist (ISC-33). Qualitative data was collected through written feedback from 28 participants and semi-structured interviewing with 24 volunteer interviewees in the experimental group. The results of this study supported the hypotheses that the Sociocultural Competency Training was effective in improving the interpersonal skills and lowering the social avoidance tendency among participants in the experimental group when compared to individuals in the control group. The hypothesis that there would be more significant change in participants' social self-efficacy was also supported. The Sociocultural Competency Training offered effective ways of helping people develop positive self-efficacy and behavioural competencies. Participants reported the training enabled them to have the sociocultural competencies to conduct their professional career in a multicultural community. In the future, the training can be used with high school students, college and university students, international students, professionals, business people, and expatriates who need to learn the sociocultural competencies for career success.

Thesis (M.B.A.)-Business Studies Unit, Durban University of Technology, 2006 xv, 200 leaves / Imbalance in the health workforce is a major challenge for health policy-makers, since human resources are the most important of the health systems input (Sanders & Lloyd) Several developed nations are increasingly relying on immigration as a means of coping with domestic shortages of health care professionals (Vujicic et al. 2004). The extent of migration and other losses of professional skills are difficult to quantify. However, the effects of these are multifaceted and have far reaching consequences for both the economy and the maintenance of health services in the country. The effects of this “brain drain” limit service delivery and limit the general population’s access to health services. The purpose of this study is to determine the effectiveness of contracting bursary students to the Department of Health (KwaZulu-Natal) as a specialist skills retention strategy.

Introduktion: Under de senaste decennierna har det förts en diskussion om behovet av att omorientera hälso- och sjukvårdens verksamhet för att på ett effektivare sätt bidra till befolkningens hälsa. Detta togs också upp som ett av målen i 2003 års svenska nationella folkhälsopolitik som sedan uppdaterades 2008. Målet ”en mer hälso- främjande hälso- och sjukvård anger att ett hälsofrämjande och sjukdomsförebyggande perspektiv ska genomsyra hela hälso- och sjukvården och vara en självklar del i all vård och behandling. Vårdpersonalen förväntas spela en nyckelroll i genomförandet. Deras inställning till och kunskap om hälsofrämjande kommer sannolikt att ha en stor inverkan på hur målet kommer att tillämpas i framtiden. Det övergripande syftet med denna avhandling är, att utifrån professionernas perspektiv, analysera möjligheterna till att omorientera hälso- och sjukvården mot en mer hälsofrämjande inriktning. De specifika frågeställningar som avhandlingen avser att besvara är hur vårdpersonalen uppfattar begreppen hälsa och hälsofrämjande, hur de uppfattar den hälsofrämjande rollen samt hur de uppfattar hinder och möjligheter för att ha en hälsofrämjande roll i det dagliga kliniska arbetet. Metoder: Avhandlingen baseras på fyra delarbeten utgående från två dataset, ett kvalitativt och ett kvantitativt. Sju fokusgrupper genomfördes med totalt 34 informanter från primärvård och olika sjukhuskliniker. Informanterna representerade sju av vårdens stora yrkesgrupper. Data analyserades med kvalitativ innehållsanalys. Uppfattningar och frågor som genererades av den kvalitativa datainsamlingen låg till grund för utformningen av en enkät, som pilottestades och användes i en undersökning. Av totalt 3.751 anställda som arbetade dagtid med kliniskt arbete i Västerbottens läns landsting inbjöds 1.810 att delta. Dessa representerade arbets- terapeuter, barnmorskor, dietister, kuratorer, läkare, sjukgymnaster, sjuksköterskor och psykologer. Huvudsakliga resultat och konklusion: Majoriteten av vårdpersonalen hade en holistisk syn på hälsa, samtidigt ansåg 40% att hälso- och sjukvården genomsyras av en biomedicinsk syn på hälsa. Begreppet hälsofrämjande framstod som diffust, svårgripbart och därmed svårt att tillämpa i praktiken. Detta var delvis kopplat till en brist på samsyn beträffande förhållandet mellan hälsofrämjande och sjukdoms- förebyggande. Avhandlingen visar att det finns ett starkt stöd för omorientering av hälso- och sjukvården mot en mer hälsofrämjande inriktning. Majoriteten av de tillfrågade ansåg att hälso- och sjukvården har stor betydelse när det gäller den långsiktiga hälso- utvecklingen i befolkningen och såg ett behov av att utveckla den hälsofrämjande och sjukdomsförebyggande rollen för att på sikt få en effektivare hälso- och sjukvård. Önskan att fokusera mer på hälsofrämjande och sjukdomsförebyggande rapporterades signifikant oftare av kvinnor än män och av primärvårdspersonal jämfört med sjukhus- personal. Speciellt viktigt att beakta är att män och läkare, dvs grupper som ofta har en hög maktposition, rapporterade mindre positiva attityder till en mer hälsofrämjande hälso- och sjukvård, samtidigt som psykologer, arbetsterapeuter och sjukgymnaster oftast rapporterade det motsatta. En medvetenhet om maktrelationerna spelar därför en strategisk roll i förändringsprocessen. De vanligaste hindren för att ha en hälso- främjande roll i det dagliga kliniska arbetet var en pressad arbetssituation, brist på riktlinjer och otydliga mål. Ledningens stöd är avgörande för tillgången till tid och andra resurser som krävs för vårdpersonal att bedriva hälsofrämjande och sjukdomsförebyggande arbete. / Introduction: There has been an on-going, active discussion about the need to re-orient health services to contribute more effectively to population health. This was addressed as one of the 2003 National Swedish public health policy goals, which demand health promotion and disease prevention be an integral part of the health care system and an important component of all care and treatment. Health care professionals are thus expected to play a key role in implementing the goal of “a more health-promoting health service”. Their approach to, and knowledge about, health promotion will consequently greatly influence how the goal will be applied in the future. The aim of this thesis is to describe and analyze the possibilities for re-orienting health services to more health promotion from the perspective of health professionals. The specific aims are to explore how health professionals interpret the concepts of health and health promotion, how they perceive their role in health-promoting practices, and how they view barriers and possibilities for having a health-promoting role in practice. Methods: The thesis is based on four studies with two sets of data. Seven focus group discussions were carried out with a total of 34 informants from both hospital and primary health care settings. The informants represented major professional groups. Data were analyzed using qualitative content analysis. Perceptions generated by the qualitative study resulted in formulation of a questionnaire that was pilot-tested and used in a survey. Out of a total of 3751 health professionals who work in daytime clinical practice in the province of Västerbotten, 1810 were invited to participate. They represented counselors, dieticians, midwives, nurses, occupational therapists, physical therapists, psychologists and physicians. Main findings and conclusions: The vast majority of informants hold holistic ideas about health. At the same time, 40% of the health professionals considered health services to be permeated by a biomedical perspective on health. The concept of health promotion appeared to be diffuse, elusive and difficult to apply in practice. This was partly linked to a lack of agreement about the relationship between health promotion and disease prevention. Thus, policy makers have to understand the need for clarification of concepts and the implications for practice. The thesis found strong support for a reorientation of health services in order to incorporate health promotion. The majority of the respondents believed that health services play a major role in long-term health development in the population and saw a need for health orientation as a strategy to provide more effective health care. Willingness to focus more on health promotion and disease prevention was reported significantly more often by women than men, and by primary health care personnel compared to hospital personnel. Especially noteworthy is that men and physicians, i.e., groups that often possess high positions of power, reported less positive attitudes to a more health-promoting health service, while psychologists, occupational therapists and physiotherapists most frequently reported the opposite. Therefore, awareness (analysis) of power relations must play a strategic role in the process of change. The most common barriers to health promotion roles in daily practice were reported to be heavy workloads, lack of guidelines, and unclear objectives. Management support is critical for the availability of time and other resources required for health professionals to engage in health promotion.

Syfte: Att undersöka vårdpersonalens känslor i mötet med våldsutsatta kvinnor inom akutsjukvården. Metod: Kvalitativ studie med halvstrukturerad intervjumetod. Tretton sjuksköterskor och undersköterskor inom akutsjukvården blev intervjuade om mötet med våldsutsatta kvinnor genom tio halvstrukturerade frågor. Resultat: Vårdpersonalen saknade kunskap om våld i nära relationer och kände sig inte beredda att möta en kvinna utsatt för våld trots framtagna riktlinjer och handlingsplaner. Mötet med våldsutsatta kvinnor väckte många starka känslor som ilska och frustration, men också medkänsla och empati. Frågan om våldsutsatthet upplevdes som komplicerad att ställa av vårdpersonalen. Faktorer som tidsbrist och bristen på avskildhet försvårade arbetet. Vårdpersonalen ansåg att det var akutsjukvårdens ansvar att ställa frågan, men det var oklart vem som bar det yttersta ansvaret. Slutsats: För att kvinnor utsatta för våld ska få ett gott omhändertagande behöver vårdpersonalen inom akutsjukvården mer utbildning och tid. Det är av betydelse att arbetsledningen eftersträvar ett öppet klimat för diskussion kring dessa frågor och markerar att våld i nära relationer är en lika viktig fråga som andra medicinska tillstånd inom akutsjukvården. / Objective: To investigate health care professionals’ emotions in the meeting with women who experience intimate partner violence within emergency care. Methods: Qualitative study with semi-structured interview methodology. Thirteen nurses and nursing assistants within the emergency care shared their thoughts in interviews about the meeting with abused women through 10 semi-structured questions. Results: Health care professionals lacked knowledge about intimate partner violence and did not feel prepared to meet an abused woman despite developed guidelines and instructions. The meeting induced many strong emotions such as anger and frustration, but also compassion and empathy. The issue was perceived as complicated by the health care professionals. Factors such as lack of time and privacy hampered their work. They felt that it was the emergency care’s responsibility to address the issue, but with different views about whose obligation it was to raise the question. Conclusion: To provide good care for abused women, the health care professionals in the emergency care need more training and time. It is important that management encourages discussion and clarifies that intimate partner violence is just as essential as any other medical issues in the emergency care.