Introduction: The COVID-19 pandemic has increased the magnitude of mental illnesses such as depression, not only in the general population, but also in healthcare personnel. However, in Peru the prevalence, and the associated factors for developing depression in healthcare personnel, are not known. The objective was to determine the prevalence and identify the factors associated with depression in healthcare personnel, in the context of the SARS-CoV-2 pandemic. Methods: An analytical cross-sectional study was carried out from May to September, 2020 in healthcare establishments. A sample of 136 health workers were included and a survey was applied to collect the data. Depression as a dependent variable was measured using the Zung self-report scale. To identify the associated factors, the bivariate and multivariate analysis was performed by logistic regression with STATA v 14. Results: The prevalence of depression was 8.8% (95%CI, 4.64-14.90). Having a family member or friend who had died from COVID-19 was associated with depression (OR = 6.78; 95%CI, 1.39-32.90; P = 0.017). Whereas the use of personal protective equipment was found to be a protective factor against developing depression (OR = 0.03; 95%CI, 0.004-0.32; P = 0.003). Conclusions: Approximately 1 in 10 healthcare professionals and technicians developed depression during the COVID-19 pandemic in this study. In addition, having relatives or friends who had died from COVID-19 was negatively associated with depression and use of personal protective equipment was identified as a protective factor. / Revisión por pares

Background: Every 40 seconds a person experience feelings of hopelessness and falls victim to suicide. The persons who are suicidal can be found all through the health care system. The health care personnel can change the outlook on life for the person, or at least ease the suffering for a while in the meeting. But health care personnel can also cause suffering by care if they don't see the person as a unique human being. Aim: The aim of this study was to highlight the suicidal persons experience meeting with health care professional. Method: A literature-based study were conducted in accordance to Friberg (2012). Analysis were made of ten qualitative scientific studies. Results: The result was presented in one theme, The significans of the relationship. And four subthemes arose; To be or not to be listened to, to feel or not to feel commitment, to be or not to be seen and to feel or not to feel trust and security. Conclusion: The result show how the persons who were suicidal experienced ease in their suffering when healthcare personnel listened, saw the person, were commited and gave a sense of trust and security. When the healthcare personnel listened and validated the persons who were suicidal it led to feelings of hope for the future. When the persons experienced that they were seen by the healthcare personnel they felt a positivity and as human beings on equal terms. When the persons who were suicidal felt security and trust for the healthcare personnel it led to a better relationship. When the persons experienced commitment from healthcare personnel they felt as they were able to let go of feelings of despair and anxiety. This resulted in a sense of wellbeing for the persons. / I Sverige begick 1189 personer självmord 2017, dessa människor såg ingen annan utväg än döden. Personerna som var självmordsbenägna hade både positiv och negativ erfarenhet av mötet med vårdpersonal. Om mötet blev dåligt ledde det till känslor av hopplöshet och när mötet blev bra kunde det leda till hopp för framtida relationer. Suicidnära personers erfarenhet av mötet med vårdpersonal visade att relationen med vårdpersonal var av betydelse och det innefattade att bli eller inte bli lyssnad på, att känna eller inte känna engagemang, att bli sedd eller inte bli sedd och att känna eller inte känna trygghet och tillit. Likt ett mynt har mötet två sidor där en sida leder till vårdlidande och den andra till ett hopp om livet. Att se personen innebar att vårdpersonal ingav hopp i mötet för personen som var självmordsbenägen. Det är därför viktigt för vårdpersonal att vara medveten om dessa personers erfarenhet för att kunna reflektera över sin egen roll, för att kunna ge god omvårdnad till hälsa och för att lindra lidande. När mötet var av positiv natur för individen kunde personerna berätta om sina innersta tankar och lära sig strategier för att ta itu med sina självmordstankar och uppleva en vändpunkt tillbaka till livet. Vårdpersonal kan göra en stor skillnad i mötet med personen som är självmordsbenägen genom att vara den livlina som gör att personen vill fortsätta leva. Att se personens lidande och lindra är vårdpersonalens uppgift, men detta sker inte alltid i mötet och det ledde till ett vårdlidande för personerna som präglades av känslor som uppgivenhet, förödmjukelse och att inte vara jämlika människor.

The overall purpose of this thesis is to investigate whether there is an association between “stress of conscience” — that is, stress related to a troubled conscience — and burnout, and to obtain an enhanced understanding of factors related to stress of conscience and burnout in healthcare. Of the four “studies” included, one uses qualitative research methods and the others use quantitative research methods. The data are based on cross-sectional questionnaire studies (I, II, and IV) and open-ended interviews (III). We could find no existing suitable instrument for measuring troubled conscience in healthcare, and so we constructed and tested the “Stress of Conscience Questionnaire” (SCQ) (I), a nine-item instrument for assessing stressful situations and the degree to which they trouble the conscience. We included 164 participants in the pilot studies, an additional 444 in the main analysis, and 55 in the test-retest verification. Participants had various occupational backgrounds and were recruited from different parts of Sweden. Our findings suggest that the SCQ is a valid and reliable measurement for use in various healthcare contexts. Cronbach’s α for the overall scale was 0.83, ensuring internal consistency. Explorative factor analysis identified and labelled two factors: “internal demands” and “external demands and restrictions”. To investigate factors related to stress of conscience and burnout (II, IV) we used a sample of 423 healthcare personnel from various specialities and with various occupations, from a district in northern Sweden. Multiple regression analysis showed that the factors related to stress of conscience (II) were: perceiving that conscience warns us against hurting others while at the same time not being able to follow one’s conscience at work, and having to deaden one’s conscience in order to keep working in healthcare; and also moral sensitivity items belonging to the factor “sense of moral burden”. In addition, deficient social support from superiors, low levels of resilience, and working in internal medicine wards were all associated with stress of conscience. The model explained 40% of the total variance. Interviews were conducted with 30 healthcare managers, to illuminate their explanatory models of the sources contributing to burnout in healthcare settings (III). The data were analysed using qualitative content analysis. The findings indicate that continuous reorganisation and downsizing of health care has reduced resources, while at the same time demands and responsibilities have increased. These problems are compounded by high ideals and expectations, making staff question their own abilities and worth. All in all this throws healthcare employees into a spiralling sense of inadequacy and an emerging sense of pessimism and powerlessness. Multiple regression analysis showed that having to deaden one’s conscience, stress of conscience from lacking the time to provide the necessary care, the work being so demanding that it influences one’s home life, not being able to live up to others’ expectations, low social support from co-workers, and low levels of resilience were all related to emotional exhaustion. Other factors that had an impact were being female, being a physician or being other healthcare professional and working in geriatric care or a primary healthcare centre. The full model explained 59% of the variance. Factors contributing to depersonalisation were: having to deaden one’s conscience, stress of conscience from not being able to live up to others’ expectations and from having to lower one’s aspirations to provide good care, deficient social support from co-workers, and being a physician; however, the percentage of variation explained was smaller (30%) (IV). The findings indicate that burnout is related to being unable to live up to one’s moral convictions; thus, it is a consequence of healthcare employees’ feeling that they are not acting on their values and for the wellbeing of the patients.

Bakgrund: Kommunikation är en grundläggande förutsättning för patientsäkerheten inom vårdorganisationen. Tidigare forskning inom området handlar till stor del om kommunikation mellan sjuksköterska och patient eller sjuksköterska och läkare. Forskning som studerar kommunikation mellan sjuksköterska och omvårdnadspersonal finns i betydligt mindre omfattning. Syfte: Att ur omvårdnadspersonalens perspektiv kartlägga kommunikationen med sjuksköterskor inom korttidsboende samt beskriva erfarenheter av kommunikation mellan sjuksköterskor och omvårdnadspersonal i omvårdnaden av patienter som vistas på korttidsboende. Metod: Enkätstudie Resultat: Resultatet visar att omvårdnadspersonalen har både bra och mindre bra erfarenheter av kommunikation med sjuksköterskor. Enligt omvårdnadspersonalen är kommunikationen betydelsefull för att patienterna ska få en god vård, men även eftersom olika yrkesgrupper arbetar i team. Rutiner för kommunikation finns och omvårdnadspersonalens erfarenhet är att dessa fungerar bra. Däremot finns oklarheter som rör rutiner vid akuta situationer. Helst och oftast sker kommunikationen genom verbal kommunikation. Omvårdnadspersonalen upplever ibland kommunkationen med sjuksköterskor som otillräcklig men samtidigt fann man också att kommunikationen ibland upplevs som överflödig. / Background: Communication is a fundamental necessity for patient security within the healthcare organization. Earlier research within the subject is largely centred around the communication between nurses and patients or nurses and physicians. Research studying communication between nurses and healthcare personnel exist to a much smaller extent. Aim: To explore communication with nurses within short-time residences from the perspective of the healthcare personnel and describe experiences of communication between nurses and healthcare personnel in the caring of patients at short-time residences. Method: Questionnaire Results: The results show that the healthcare personnel hold both good and bad experiences of communication with the nurses. According to the healthcare personnel, the communication is vital to provide good treatment for the patients, but also since certain workgroups function in teams. There is existing routines for communication, and the healthcare personnel experience that these routines functions well. On the contrary there is obscurity concerning routines in acute situations. Preferably, and most often, the communication is verbal. The healthcare personnel sometimes feel that the communication with the nurses is insufficient, but also found some information to be unnecessary.

<p><strong>Bakgrund: </strong>Kommunikation är en grundläggande förutsättning för patientsäkerheten inom vårdorganisationen. Tidigare forskning inom området handlar till stor del om kommunikation mellan sjuksköterska och patient eller sjuksköterska och läkare. Forskning som studerar kommunikation mellan sjuksköterska och omvårdnadspersonal finns i betydligt mindre omfattning.</p><p><strong>Syfte:</strong> Att ur omvårdnadspersonalens perspektiv kartlägga kommunikationen med sjuksköterskor inom korttidsboende samt beskriva erfarenheter av kommunikation mellan sjuksköterskor och omvårdnadspersonal i omvårdnaden av patienter som vistas på korttidsboende.</p><p><strong>Metod: </strong>Enkätstudie</p><p><strong>Resultat</strong>: Resultatet visar att omvårdnadspersonalen har både bra och mindre bra erfarenheter av kommunikation med sjuksköterskor. Enligt omvårdnadspersonalen är kommunikationen betydelsefull för att patienterna ska få en god vård, men även eftersom olika yrkesgrupper arbetar i team. Rutiner för kommunikation finns och omvårdnadspersonalens erfarenhet är att dessa fungerar bra. Däremot finns oklarheter som rör rutiner vid akuta situationer. Helst och oftast sker kommunikationen genom verbal kommunikation. Omvårdnadspersonalen upplever ibland kommunkationen med sjuksköterskor som otillräcklig men samtidigt fann man också att kommunikationen ibland upplevs som överflödig.</p> / <p> </p><p><strong>Background:</strong> Communication is a fundamental necessity for patient security within the healthcare organization. Earlier research within the subject is largely centred around the communication between nurses and patients or nurses and physicians. Research studying communication between nurses and healthcare personnel exist to a much smaller extent.<strong></strong></p><p><strong>Aim: </strong>To explore communication with nurses within short-time residences from the perspective of the healthcare personnel and describe experiences of communication between nurses and healthcare personnel in the caring of patients at short-time residences.</p><p><strong>Method: </strong>Questionnaire</p><p><strong>Results: </strong>The results show that the healthcare personnel hold both good and bad experiences of communication with the nurses. According to the healthcare personnel, the communication is vital to provide good treatment for the patients, but also since certain workgroups function in teams. There is existing routines for communication, and the healthcare personnel experience that these routines functions well. On the contrary there is obscurity concerning routines in acute situations. Preferably, and most often, the communication is verbal. The healthcare personnel sometimes feel that the communication with the nurses is insufficient, but also found some information to be unnecessary.</p>

Bakgrund: Personer med intellektuell funktionsnedsättning har en ökad risk för fysisk och psykisk ohälsa och lider av samsjuklighet i större grad än övriga befolkningen. Medellivslängden för personer med intellektuell funktionsnedsättning har ökat vilket leder till en växande grupp människor med särskilda behov som behöver tillgodoses av hälso- och sjukvården. Syfte: Syftet med litteraturstudien var att beskriva vårdpersonals erfarenheter av att vårda personer med intellektuell funktionsnedsättning. Metod: Litteraturstudie med kvalitativ ansats där åtta vetenskapliga studier som svarade mot syftet valdes ut, kvalitetsgranskades, analyserades och sammanställdes. Artikelsökningen genomfördes i databaserna Cinahl, PsycInfo, PubMed och Scopus. Resultat: Analysen resulterade i fyra huvudkategorier med sammanlagt nio underkategorier. Vårdpersonalen beskrev erfarenheter av otillräcklighet och organisatoriska hinder, svårigheter och möjligheter i kommunikationen, betydelsen av goda relationer samt känslor kring utmanande beteende och preventiva åtgärder mot utmanande beteende.Konklusion: Vårdpersonal upplever hinder för att ge god vård till personer med intellektuell funktionsnedsättning. För att överkomma hinder krävs en öppen attityd, en vilja att lära känna personen, en god relation till familjen och personliga assistenter samt ett bra team-arbete. / Background: People with intellectual disabilities are at increased risk for physical and mental illness and suffer from comorbidity in greater degree than the rest of the population. Life expectancy for people with intellectual disabilities has increased, leading to a growing group of people with special needs that must be met by the health sector. Aim: The aim of this study was to describe healthcare personnel´s experiences of caring for people with intellectual disabilities. Method: Literature study with qualitative design. Eight scientific studies that corresponded with the aim was selected, quality assessed, analyzed and compiled. Databases used to search for articles was Cinahl, PsycInfo, PubMed and Scopus. Results: The analysis resulted in four main categories with a total of nine subcategories. Healthcare personnel described experiences of inadequacy and organizational constraints, difficulties and possibilities in communication, the importance of good relationships and their feelings about challenging behavior and preventive measures against challenging behavior.Conclusion: Healthcare personnel´s experience obstacles in providing good care to people with intellectual disabilities. In order to overcome the obstacles it requires an open attitude, a willingness to get to know the person, a good relationship with the family and the personal-assistants and a good teamwork.

Bakgrund: Patienter med substansbruksyndrom ökar i vården och därmed sjukvårdspersonalens kontakt med denna patientgrupp. Sjukvårdpersonal har ansvar för att ge vård till patienter på lika villkor samt ha ett gott bemötande.  Sjukvårdpersonalens attityder inverkar på patientens upplevelse av bemötande och vårdkvaliteten vilket i sin tur påverkar deras tillit till sjukvården.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Syfte: Syftet med studien var att undersöka vårdpersonals erfarenheter av att vårda samt attityder till patienter med substansbruksyndrom på avdelningar där inte endast missbruksvård bedrivs. Metod: En litteraturstudie genomfördes och inkluderade 10 artiklar med kvalitativ ansats. Dessa har granskats, analyserats och sammanställts med hjälp en integrativ litteraturöversikt. Sökningarna utfördes i databaserna Cinahl, PsychInfo och Pubmed. Resultat: Tre huvudkategorier och sju subkategorier identifierades. De tre huvudkategorierna innefattade: Synen på och erfarenheter av patienter med missbruksproblematik, Synen på att vårda patienter med missbruk, och Synen på uppkomst och ansvar över missbruk.  Slutsats: Vårdpersonals attityder till patienter med missbruk varierar, dock visar studien på att det förekommer negativa attityder till dessa patienter. Det resulterar i att vården ofta blir mer uppgiftsorienterad och mindre individorienterad. Litteraturstudien visar även att vårdpersonal med erfarenhet och utbildning inom missbruk generellt har en mer positiv attityd till patienter med missbruksproblematik. Det tyder på att det behövs mer utbildning av vårdpersonal för att negativa attityder gentemot patienter med missbruksproblematik ska undvikas. / Background:The number of patients with substance use disorder are increasing within the healthcare system, therefore is also the contact between this patient group and the healthcare personnel becoming more frequent. It is the healthcare personnel’s responsibility to give equal care to all patients, including a respectful treatment. The attitude of the healthcare personnel will influence the patient’s experiences of how they are approached and the quality of the care they receive, which in turn affects the patients trust in the healthcare system.  Aim:The Aim of this study was to explore healthcare personnel’s experience of caring for patients with substance use disorder and their attitudes towards this patient group, in non-specialist settings.  Method:A literature study was conducted including 10 articles with a qualitative approach. These articles have been reviewed, analysed and compiled with help of an integrative literature review. Database searches have been executed in Cinahl, PsychInfo and Pubmed. Result:Three major categories and seven subcategories were identified. The three major categories included: The view and experiences of patients with substance misuse, The view on care for patients with substance misuse, and The view on responsibility and origin of misuse. Conclusion:Attitude towards patients with substance use disorder varies among healthcare personnel, however this study indicates that the attitudes are predominantly negative. This results in a care that are often more task oriented, and less orientated toward the individual. Furthermore, the literature study also demonstrates that more educated and experienced healthcare personnel usually express a more positive attitude toward this group of patients. This indicates that there is a need to educate healthcare personnel to avoid negative attitudes towards patients with substance use disorder.

Bakgrund: Våld i nära relationer är ett globalt problem med stora effekter på kvinnors hälsa. Tidigare forskning visar att våldsutsatta kvinnor upplever brister i det bemötande de fått av vårdpersonal. Akutmottagningen är ofta våldsutsatta kvinnors första, och ibland enda, kontakt med hälso- och sjukvård. Vårdpersonal på akutmottagning har därmed goda förutsättningar att uppmärksamma och vårda denna patientgrupp.   Syfte: Studien syftar till att beskriva vilka erfarenheter kvinnor som blivit utsatta för våld i nära relationer har av mötet med vårdpersonal på akutmottagning.   Metod: En systematisk litteraturstudie med kvalitativ innehållsanalys av sex kvalitativa artiklar och en artikel med mixad metod utifrån vilka tre kategorier identifierades.   Resultat: Kvinnor som blivit utsatta för våld i nära relationer har både negativa och positiva erfarenheter av mötet med vårdpersonal när de söker vård på akutmottagning. Bristande bemötande visade sig genom att kvinnorna kände sig skuldbelagda och att vårdpersonalen uppvisade bristande empati och inte såg bortom kvinnornas fysiska skador. I motsats till detta har en del kvinnor upplevt tillfredsställande bemötande som visade sig genom att vårdpersonalen upplevdes som hjälpsamma och medlidande med en attityd som var empatisk och förstående.   Slutsats: För att främja ett gott bemötande från vårdpersonal gentemot den utsatta kvinnan, visade det sig finnas ett behov av kunskap och utbildning kring våldsutsatta kvinnors situation och vilka vårdbehov de kan ha. Ett gott bemötande ökar patientens känsla av delaktighet, lindrar lidande och motverkar att lidande uppkommer till följd av vård.

The thesis comprises four papers. The overall aim was to illuminate meanings of becoming and being burnt out respectively not becoming or being burnt out. The papers deal with two groups of healthcare personnel, one group on sick leave due to medically assessed burnout (n=20) and one group who showed no indications of burnout (n=20) from the same workplaces at psychiatric (n=7) and elderly (n=7) care units. A further aim was to describe personality traits and to elucidate perceptions of conscience (PCQ), stress of conscience (SCQ), moral sensitivity (MSQ-R), social support (SocIS) and resilience (RS) among the people in these two groups. Papers I and II are based on the text of narrative interviews interpreted using a phenomenological-hermeneutic method. Papers III and IV are based on data, pertaining to the same participants as in Papers I and II, derived from the following questionnaires; Cattell’s Sixteen Personality Factors Questionnaire (16PF) (III), ‘Perception of Conscience’ (PCQ), ‘Stress of Conscience’ (SCQ), ‘Moral Sensitivity Revised’ (MSQ-R), ‘Social Interactions Scale’ (SocIS) and ‘Resilience Scale’ (RS) (IV). Conventional statistical methods and Partial Least Square Regression (PLSR) were used to analyse the data (III, IV). In Paper I the aim was to illuminate meanings of becoming and being burnt out as narrated by healthcare personnel. The results show that meanings of becoming and being burnt out is to be torn between what one wants to manage and what one can actually manage. It is as if one’s ideals become more like demands for, regardless of the circumstances, one must be and show that one is capable and independent. It also means being dissatisfied with oneself for not living up to one’s own ideals as well as being disappointed in other people for not providing the confirmation one strives for. Feelings that one is a victim of circumstances emerge. Becoming and being burnt out leads to a futile struggle to live up to one’s ideals and when failing to unite one’s ideal picture with one’s reality one finally reaches an overwhelming feebleness. In Paper II the aim was to illuminate meanings of not becoming or being burnt out at workplaces where others developed burnout, as narrated by healthcare personnel. The results show that meanings of not becoming or being burnt out are to be rooted in an outlook on life which perceives its many-sidedness of prosperity, adversity, strength and weakness in oneself and others. An openness towards the circumstances of life emerges. Being able to judge the possibilities of influencing things, as well as being able to let go of injustice and look after oneself with a clear conscience are revealed as meanings of not becoming and being burnt out. In Paper III the aim was to describe personality traits among burnt out and non-burnt out healthcare personnel from the same workplaces. The results show, that the people in the burnt out group had lower scores regarding emotional stability and higher scores regarding anxiety than the people in the non-burnt out group but the results also showed a wide variation of personality traits within the groups. The most important indicators for belonging to the burnt out group were openness to changes and anxiety, and for belonging to the non-burnt out group, emotional stability, liveliness, privateness and tension. In Paper IV the aims were to elucidate perceptions of conscience, stress of conscience, moral sensitivity, social support and resilience among burnt out and non-burnt out healthcare personnel from the same workplaces. The results show that higher levels of stress of conscience and moral sensitivity, a perception of conscience as a burden, having to deaden one’s conscience in order to keep working in healthcare and perceiving a lack of support from those around them characterize the burnt out group. Those in the non-burnt out group are characterised by lower levels of stress of conscience, an out-look on life with a forbearing attitude, a perception of conscience as an asset, an ability to deal with one’s conscience in a constructive way and a perception of receiving support from those around them. The comprehensive understanding from the four papers (I-IV) is discussed in light of a theoretical framework derived from Emmy van Deurzens thoughts about the four life worlds: the natural world (the physical world), the public world (the social world), the private world (the psychological world) and the ideal world (the spiritual world). The result can be summarized in terms of the human condition in life and demonstrates the essential importance of reconciling the vita activa (the active life of labor, work and action), the vita contemplativa (thinking, willing and judging) and not least the vita regenerativa (rest and recovery) in order to avoid being burned out. / Samvetsstress i vården

Bakgrund: Endometrios är en östrogenberoende sjukdom som främst drabbar kvinnor i fertil ålder och tar ofta lång tid innan den diagnostiseras. Besvären från endometrios kan leda till ett långvarigt lidande med grav smärta, påverka den drabbades arbetsförmåga, sociala tillvaro och möjligheten att bli gravid. Syfte: Syftet med denna studie var att beskriva personer med endometrios erfarenheter i mötet med sjukvårdspersonal, samt att beskriva de inkluderade artiklarnas datainsamlingsmetoder. Metod: Beskrivande litteraturstudie. Resultat: Denna litteraturstudie visade att personer med endometrios erfarenheter av mötet med sjukvårdspersonal ofta präglas av att de endometriosdrabbade kände sig nonchalerade, inte blev tagna på allvar och att de, efter fastställd endometriosdiagnos, upplevde att sjukvårdspersonalen ställde orimliga krav på dem. Att mötas av empatisk och kunnig sjukvårdspersonal sågs som positivt. Slutsats: Kunskapen om sjukdomen endometrios behöver utökas både hos sjukvårdspersonalen och allmänheten för att garantera tidigare diagnos. Då sjuksköterskan är en av de professioner som de vårdsökande oftast kommer i kontakt med är god kunskap hos sjuksköterskan en förutsättning för god omvårdnad och ett led i att förbättra bemötandet gentemot de endometriosdrabbade.