Många personer över 65 år lever med smärta. Det ingår i sjuksköterskans arbetsuppgifter att bedöma och utvärdera smärta. Syfte: Syftet med denna litteraturstudie var att genom existerande forskning beskriva vårdpersonals kunskap och attityder till smärtbedömning och smärtskattning i sitt dagliga arbete vid vård av äldre. Metod: I denna litteraturstudie användes sökbaserna Cinahl och Pubmed. Resultat: Resultatet baseras på 10 artiklar, 7 kvantitativa , 2 kvalitativa och en artikel där båda metoderna användes. De faktorer som påverkar smärtskattningen sågs vara erfarenhet och utbildning, utbildning i smärtskattning visade sig öka självförtroendet hos personalen. Även olika hinder, så som kognitiv nedsättning hos patienten och tidsbrist för vårdpersonalen, ligger i vägen för en adekvat smärtskattning. Generellt hade vårdpersonalen en positiv inställning till utbildning inom området smärtbedömning och även en stor intention att smärtskatta och göra detta korrekt. Det kunde ses att vårdpersonalens fördomar och attityder till äldres smärta påverkade smärtbedömningen. Slutsats: Smärtskattning av den äldre patienten är av största vikt för att minska smärta, lidande och andra följdtillstånd som obehandlad smärta orsakar. Med stöd från den samlade litteraturen, anses även att utbildning av personalen är ett mycket viktigt sätt att utveckla och förbättra smärtbedömningen inom vården. / Many people over the age of 65 are living with pain. It’s a part of the nurse profession to assess and evaluate pain. Purpose: The purpose of this literature review was by existing research explore nurses knowledge and attitudes towards pain assessment and pain measurement in the care of elderly patients. Methods: In this literature review the databases Cinahl and Pubmed were used. Results: The results in this study are based on 10 articles. 7 quantitative, 2 qualitative and 1 were both methods was used. Factors that influenced how the patients’ pain was assessed by the health care givers was experience and education, attitudes and different obstacles that made adequate assessments difficult, such as patients having cognitive impairment and lack of time to perform assessment. In general, the caregivers had a positive attitude towards education about pain assessment and a great intention to assess pain correctly. However, it could be shown that negative attitudes and prejudices against pain in the older patient and how it should manifest affected how the pain assessment was performed. Conclusions: Negative attitudes regarding aging that is still exists in our society is affecting the health care of the individual. The authors believe, in support of the reviewed literature, that education is an important way to improve and develop the pain assessment performance.

Background: Family caregivers represent a critical component in the management of the health of older adults. The inclusion of family caregivers during transitions occurring between hospital and community settings has been previously considered. However, the experience of family caregivers during transitions occurring within the same setting remains unclear. The purpose of this study was to describe the experiences of family caregivers during transitions occurring within an acute care setting. Method: A qualitative description study was conducted. Semi-structured interviews were conducted with 10 family caregivers. Interviews were audio-recorded and occurred in person or over the telephone. Analysis included coding of interview data and the development of overarching themes. Findings: In this study, family caregivers reported the following themes. These themes included: "a lack of central brain during hospitalization," "muddling through transitions alone" and "wariness towards the care delivery system. The environmental influence of the hospital setting influenced family caregivers' view of the care provided by healthcare professionals and the transitions occurring between different units. Furthermore, half of the family caregiver participants (n=5) identified as having a background in healthcare. Healthcare professionals as family caregivers (HCP-FCs) reported unique experiences from other non-healthcare family caregivers. Interviews and field notes from HCP-FC participants were analyzed separately following the same procedures as the larger study. Three themes emerged including, "seeking inclusion," "insider perspectives," and "role struggle." Conclusion: Experiences of HCP-FCs and family caregivers during hospitalization of older adults have the potential to influence perceptions regarding transitional events occurring within acute care settings. Additionally, family caregivers' and HCP-FCs' perceptions of care coordination among healthcare professionals had the potential to negatively influence perceptions of transitions occurring within the acute care setting.

The Numeric Rating Scale (NRS) is suitable in postoperative settings, yet, the implementation has shown varying results. This has raised issues about the pain scales contribution to the identifying and understanding of pain. The aim of this thesis was to describe the clinical utility of patients’ self-rated postoperative pain after major surgery from a healthcare professional perspective. The aim of study I and II was to describe healthcare professionals’ perceptions of the use of pain scales, and to through considering critical incidents describe care experiences and actions taken by healthcare professionals’ when assessing pain. Participants in study I (N=25) and II (N=24) were enrolled- registered nurses and physicians with clinical experiences of pain scales. The aims of study III and IV were to determine the clinical applicability of NRS mode- and maximum- measures, and the NRS mode- and median measures at rest and during activity based on patients self-rated pain. The aim in study IV was additionally to determine the number of NRS ratings needed for the calculation of these measures. The number of surgical and orthopedic patients who completed study III were: n=157 and study IV: n=479. Study I and II confirmed earlier findings of patients’ self-reported pain scores as a facilitator in the understanding of their postoperative pain. Organizational routines, documentation devices, clinical competence, continuity in care, collaborative actions, time, and individual routines were healthcare related factors affecting the use of pain scales (I, II). Patient-related facilitating factors were patients’ ability and willingness to communicate pain, while disability and unwillingness to communicate or inconsistency in verbal communication with observed behaviors were barriers (II). Time and multidimensional communication approaches could bridge these barriers (I, II). Study III and IV showed acceptable reliability for the mode, median and maximum measures. Rank correlations for individual median scores, based on four ratings, versus patients’ retrospective self-rated average pain, were moderate and strengthened with increased numbers of ratings. The Svensson method showed an individual variation within the expected outcome and a significant systematic group change towards a higher level of reported retrospective pain. The calculated pain measures, particularly concerning pain at rest, generally were lower than patients’ recall of pain. The findings described beneficial effects of patient self-reported pain, however present healthcare did not fully support the utilization of pain scales. Because of the simple measurement characteristics, the use of daily NRS average pain measures, patients’ pain can be followed until resolved. The measures could additionally become important patient reported outcome measures and thus constitute new motivators to increase the utilization of pain scales.

Bakgrund: Smärta är en av de vanligaste orsakerna till varför patienter uppsöker vård. Akut smärta beskrivs som subjektiv och individuell vilket styrker nödvändigheten av ökad kunskap och förståelse för akut smärta och patienters olika upplevelser av den.  Detta skulle kunna generera i en bättre omvårdnad, där utvecklingen från akut smärta till en kronisk långvarig smärta samt ett lidande för patienten skulle kunna minimeras. Syfte: Syftet var att beskriva patienters upplevelse av akut smärta och vårdpersonalens betydelse i samband med den. Metod: En litteraturöversikt som baseras på 13 artiklar, sju kvalitativa och sex kvantitativa. Resultat: Fyra teman identifierades; "Vikten av adekvat smärtbehandling", "Vårdpersonalens kompetens inger trygghet", "Att underkasta sig vårdpersonalen" samt "Betydelsen av kommunikation och information". Konklusion: Akut smärta är fortfarande ett stort problem och alldeles för många patienter lider av akut smärta. Vårdpersonalen har stor betydelse för dessa patienters upplevelse då det kan lindra smärtan och förebygga onödigt lidande. För att förbättra vården för patienter med akut smärta behövs en ökad förståelse och kunskap för deras subjektiva upplevelser men även betydelsen av hur sjuksköterskan agerar, behandlar och utvärderar är viktig. / Background: Pain is one of the most common reasons why patients seek healthcare. Acute pain is described as subjective and individual, which proves the need for greater knowledge and understanding of the acute pain and the patient's different experiences of it. This could generate in a better care, where the development of acute pain to chronic prolonged pain and the suffering of the patient could be minimized. Aim: The aim was to describe the patients’ experience of acute pain and the significance of health care professionals associated with it. Method: A literature review based on 13 articles, seven qualitative and six quantitative.   Results: Four themes where identified; "The importance of adequate pain management",”To submit to the health care professionals”, “How the health care professionals’ competence incites a sense of safety” and ”The significance of communication and information”. Conclusion: Acute pain is still a major problem and too many patients suffers from it. The health care professionals have a great importance for these patients’ experience since they can ease the pain and prevent unnecessary suffering. To improve care for patients with acute pain, a greater understanding and knowledge of their subjective experiences is required but also the significance of how the nurse act, treats and evaluates should be of importance.

Background: Abortion continues to be stigmatized in Ghana even though Ghana has one of the most liberal abortion laws in West Africa. This stigmatization discourages women from having safe abortion and discourages the health care professionals to provide services for abortion. The recruitment of healthcare providers is therefore marginalized, isolated and difficult. Aim: The aim of the study is to describe the healthcare professionals’ experiences of working with the abortion care in Ghana. Method: Five qualitative, semi-structured interviews were conducted with healthcare professionals working at two different governmentally owned hospitals in Ghana. The findings were analysed with qualitative content analysis. Results: Four main themes emerged in this study describing healthcare professionals’ experiences of working with abortion care in Ghana; Context, Nursing care, Challenges and Saving lives. The healthcare professionals work is stigmatized and challenging but the best part of their profession was helping adolescents, families and saving lives. Conclusion: To save lives, enhance the working situation for the healthcare professionals and to reduce stigma, education and better working environment is necessary. / Bakgrund: Abort fortsätter att vara stigmatiserat i Ghana trots att Ghana har en av de mest liberala abortlagarna i Väst Afrika. Stigman avskräcker kvinnor från säker abort och hindrar hälso- sjukvårdspersonalen att tillhandahålla tjänsten för abort. Anställingen av hälso-sjukvårdspersonalen är därför marginaliserad, begränsad och svår. Syfte: Att beskriva hälso-sjukvårdspersonalens erfarenheter av att arbeta med abortvården i Ghana. Metod: Fem kvalitativa, semi-strukturerade intervjuer utfördes med hälso-sjukvårdspersonal från två olika sjukhus i Ghana. Kvalitativ innehållsanalys användes för att analysera insamlad data. Resultat: Hälso-sjukvårdspersonalens erfarenheter och åsikter om att arbeta med abortvård beskrevs med fem huvudteman: Kontext, Omvårdnad, Utmaningar och Rädda liv. Hälso-sjukvårdspersonalens arbete är stigmatiserat och utmanande men den bästa delen av deras profession var att hjälpa ungdomar, familjer och att rädda liv. Slutsats: För att kunna rädda liv, förbättra arbetssituationen för hälsosjukvårdspersonalen och för att minska stigman är utbildning och bättre arbetsmiljö nödvändigt.

Background: Studies show that healthcare professionals often experience ethical difficulties in their relations with patients, relatives, and other professionals and in relation to organisational issues, and these can sometimes be difficult to handle. Failing to act or to relate in accordance with one’s values for what is good and right might cause a troubled conscience that is connected to feelings of guilt and ill-being. Ethical issues related to the care of patients with end-stage renal disease have been described, but no studies in this context have been found that explore registered nurses’ (RNs’) and physicians’ experiences of being in ethically difficult situations that give rise to a troubled conscience. The importance of communicating ethical issues in order to understand and handle ethically difficult care situations has been emphasized. Various forms of clinical ethics support (CES) have been described and evaluated, but studies on the communication processes and the organisation of CES interventions are sparse and no study describing a CES intervention based on Habermas’ theory of communicative action has been found. Aim: The overall aim was to increase our understanding about being in ethically difficult care situations and about how communication concerning ethical issues in healthcare can be promoted. More specifically, the aim of studies I and II was to illuminate experiences of being in ethically difficult situations giving rise to a troubled conscience among RNs and physicians, while studies III and IV aimed to describe the communication of value conflicts (III) and the organisation and performance of a CES intervention (IV). Methods: In studies I and II narrative interviews with ten RNs (I) and five physicians (II), were performed in a dialysis care context. The interviews were analysed using a phenomenological hermeneutic approach. In studies III and IV, eight audio- and video-recorded and two audio-recorded sessions of the CES intervention, were conducted and sorted by the data tool Transana and analysed in accordance with a qualitative content analysis (III) and a qualitative concept- and data-driven content analysis (IV). Results: The RNs’ narratives (I) resulted in the theme ‘Calling for a deliberative dialogue’. Their narratives expressed feelings of uncertainty, solitude, abandonment, and guilt in complex and ambiguous ethically difficult situations. The narratives concerned the value conflict between preserving life by all means and preserving life with dignity. The physicians’ narratives (II) resulted in the themes ‘Feeling trapped in irresolution’ and ‘Being torn by conflicting demands’. Their narratives expressed feelings of uncertainty, solitude, abandonment and guilt related to the obligation to make crucial decisions and in situations when their ideals and the reality iii clashed. The analysis of the communication of value conflicts during the CES intervention inspired by Habermas’ theory of communicative action (study III) revealed a process of five phases: a value conflict expressed as feelings of frustration, sharing disempowerment and helplessness, revelation of the value conflict, enhancing realistic expectations of the patients and relatives, and seeing opportunities to change the situation instead of obstacles. The CES intervention (study IV) was organised as a framework with a given structure and an openness for variations to facilitate communicative action. Three courses of actions to reach a communicative agreement were identified and concerned the approach to achieve a permissive communication, opening up for extended views, and enhancing mutual understanding (IV). Conclusion: The results show that both RNs and physicians expressed feelings of uncertainty abandonment and loneliness in similar ethically difficult situations but from different points of view. They struggled with the same value conflicts and feelings, but they did not share their struggles with each other. The lack of communication and confirmation led to distrust and increased feelings of uncertainty. The CES intervention, inspired by Habermas’ theory of communicative action, offered the possibility of dealing with experiences of ethically difficult care situations. In the permissive atmosphere, the professionals helped each other to balance their ambiguity, frustrations, and powerlessness and came to an agreement about how to handle the value conflicts and how to act. The findings from this CES intervention constitute a step towards a CES method that is clearly described so that leaders can be educated and extended intervention studies with different kinds of data can be conducted in order to further develop knowledge about how to promote an inter-professional dialogue about ethical difficulties.

En quoi peut-on définir un individu compétent en éthique ? Si la compétence éthique se caractérise par une capacité à adopter la manière d’agir la plus ajustée à la situation vécue, la confrontation aux réalités de terrain doit mettre en évidence les débats de normes sous-jacents à cette compétence éthique. Nous nous proposons de la rendre plus lisible et de la réactualiser en repérant les éléments qui constituent l’activité de travail, notamment celle des professionnels de santé à l’œuvre dans les hôpitaux publics de Marseille (APHM). Comment être compétent en éthique dans des services accueillant un public hétérogène du point de vue des maladies, de la culture et des valeurs ? Dans la lignée des travaux en ergologie, cette étude propose d’appréhender la compétence éthique en donnant la parole au travail et en analysant les savoirs et les « usages de soi » des soignants. / How can we define a competent individual in ethics ? If ethical skill is characterized by an ability to adopt the way to act as fairas possible to the lived situation, the confrontation with realities must highlight debates of standards underlying the ethical skill. We propose to make it more readable and to update it by identifying the elements that constitute the work activity, in particular that of healthcare professionals at work in the public hospitals of Marseille (APHM). How to be competent in services welcoming a heterogeneous public from the point of view of the diseases, of the culture and the values ? In the line with Ergologie’s work, this study proposes to perceive ethical skill with language exists in work and analyzing the knowledge and the « uses of one » of the nursing staff.

Bakgrund: Cirka 130 000-150 000 personer i Sverige har en demenssjukdom. Demens är en obotlig sjukdom som kan leda till exempelvis minnessvårigheter, svårigheter att kommunicera, svårigheter att sköta sin personliga hygien. På grund av dessa symtom kan omvårdnaden av personer med demenssjukdom vara en svårighet för vårdpersonalen och de kan ställas inför olika utmaningar. Syfte: Att beskriva vårdpersonalens erfarenheter kring utmaningar i omvårdnad av personer med demenssjukdom. Metod: Litteraturöversikt där resultatet är baserat på arton vetenskapliga artiklar. Resultat: I resultatet har författarna till denna litteraturöversikt studerat vårdpersonalens erfarenheter av utmaningar kring omvårdnad av personer med demenssjukdom. Vid olika situationer i omvårdnaden av personer med demenssjukdom identifierades svårigheter och utmaningar för vårdpersonalen. Utmaningar som urskiljes: Bevara integritet eller förebygga skada, personlig hygien, administrera läkemedel, måltidssituationer, att undanhålla sanning för att lugna, teknisk övervakning och kommunikation. Slutsats: Det finns flera utmaningar inom omvårdnad av personer med demenssjukdom, där vårdpersonalen ställs inför valet att främja individens självbestämmande och integritet eller att förebygga skador genom att gå emot individens vilja. / Background: Around 130 000-150 000 people in Sweden is suffering from dementia. Dementia is a terminal illness which can lead to memory loss, difficulty in communication and difficulties to manage their personal hygiene. Due to these symptoms, the care of people with dementia can be challenging and healthcare professionals are often faced with problematic questions. Aim: Describe healthcare professionals experiences concerning care of people affected by dementia. Method: A literature review, including eighteen scientific articles. Results: The authors to this systematic review has been studying the health care professionals experiences with different challenges within the healthcare of people with dementia. In different situations difficulties and challenges could be identified for the healthcare professionals. These challenges could include: maintain integrity or prevent injuries, personal hygiene, administration of medicinal products, meal situations, withhold the truth to keep the calm, technical monitoring, communication. Conclusion: Within the healthcare of people with dementia it occurs several dilemmas. The healthcare professionals are facing the choice between the individuals right to autonomy and integrity or provide against injury by acting against the patients individual will.

Psykisk ohälsa hos unga vuxna ökar och behovet av vårdinsatser blir större. Anhöriga ses numer som en resurs i dessa vårdinsatser. Trots detta visar tidigare forskning att samhällets insatser för att främja anhörigkontakterna delvis är undermålig. Kommunikation och samarbete mellan anhöriga och vårdpersonal är ett område som lyfts fram som ett av problemområdena. Syftet med denna studie var att undersöka och skapa en djupare förståelse om föräldraskap till barn med långvarig psykisk sjukdom. Detta genom att beskriva hur vårdpersonalen upplever mötet med föräldrar till barn med psykisk sjukdom.          Studien utfördes med intervjuer av fyra personer som arbetade inom olika vårdinrättningar som kom i kontakt med föräldrar till vuxna barn med psykisk sjukdom och analyserades genom kvalitativ innehållsanalys. Resultaten redovisades med tre teman: Vårdpersonalens perspektiv, Förälders perspektiv och Framtid. Resultatet visade på problematiken kring föräldrarnas misstro gentemot vårdinsatser men jämfört med tidigare forskning framkom att alla fyra intervjupersoner upplevde till största delen bra möten med dessa föräldrar. Återkommande faktorer som skulle kunna förbättra eventuella problem framkommer där tid, information och kunskaper är viktiga komponenter. Resultaten visade även betydelsen av bra arbetsmiljö och vikten av en professionell chef. / Abstract Mental illness amongst young adults is increasing and the need for care interventions becomes greater. Relatives are now seen as a resource in these care interventions. In spite of this, previous research shows that society's efforts to promote contacts with relatives are partly substandard. Communication and cooperation between relatives and healthcare professionals is an area highlighted as one of the problem areas. The purpose of this study was to investigate and create a deeper understanding about parenting to children with long-term mental illness. This is by describing how health professionals experience the meeting with parents of children with mental illness.           The study was conducted with interviews of four people working in different health care institutions that met parents of adult children with mental illness and were analyzed through qualitative content analysis. The results were reported with three themes: Healthcare professionals ' perspective, Parent's perspective and future. The result showed the problem of parental distrust in care, but was in relation to previous research relatively positive, that all four respondents experienced mostly good meetings with these parents. Recurring factors that could improve potential problems arise where time, information and knowledge are important components. The results also showed the importance of a good working environment and the importance of a professional manager.

Bakgrund: Demenssjukdom är en global sjukdom som ökar i antal insjuknade för varje år. Fysiska och kognitiva förmågor försämras ständigt under sjukdomsförloppet. Det är vanligt att person och/eller personer med demenssjukdom (PMD) drabbas av malnutrition eftersom de glömmer av att äta och hur de ska äta. Vårdpersonalen behöver därför kunskap om hur måltidssituationer för PMD kan anpassas efter de behov som finns och hur matintaget kan ökas. Syfte: Att belysa aspekter av vårdpersonals kunskap kring måltidssituationer för personer med demenssjukdom på särskilt boende. Metod: En litteraturöversikt baserat på 15 vetenskapliga artiklar. Elva artiklar var av kvalitativdesign och fyra artiklar var av mixad design. Databaserna som användes vid artikelsökning var CINAHL och PubMed. Resultat: Ett huvudresultat visade att vårdpersonalen behövde mer kunskap vid måltidssituationer för att bidra med ökat matintag hos PMD. Genom att vårdpersonalen anpassade måltidssituationer i enlighet med PMD förmågor kunde behoven lättare tillfredsställas. Vårdpersonalen tog hänsyn till bland annat möblering, ljud, ljus och servering för att minska oönskade stimuli vid måltidssituationer för PMD. Slutsats: Vårdpersonalen hade kunskap men inte tillräcklig för att kunna utföra en optimal omvårdnad till PMD. Behoven bland PMD är många och kunskapsbrist hos vårdpersonalen råder. Kunskapsbristen hos vårdpersonalen om måltidssituationer blir tydliga då PMD inte har tillräckligt matintag för att upprätthålla en god nutritionsstatus. / Background: Dementia is a global disease that increases for every year. Physical and psychological abilities reduce continuously during the disease course. It is usual that people with dementia is affected by malnutrition since they forget how and when to eat. Healthcare professionals’ need more knowledge about mealtime situations for people with dementia and how to customize their needs about increasing food intake. Aim: To illustrate aspect of healthcare professional’s knowledge about mealtime situations for people with dementia in nursing homes. Method: A literature review based on 15 research articles. Eleven articles were qualitative design and four were mixed design. Used databases were CINAHL and PubMed. Results: A main result showed that healthcare professionals needed more knowledge about mealtime situations and how to provide increased food intake. Healthcare professionals adjust mealtime situations according to the abilities that people with dementia had. Healthcare professionals did consideration about different kind of arrangement to reduce stimuli in mealtime situations for people living with dementia. Conclusion: Healthcare professionals had knowledge about nursing for people with dementia but not enough. The needs among people living with dementia are many and the lack of knowledge in healthcare professionals' work is not approval. In mealtime situations the lack of knowledge about optimal nutrition status among people with dementia and surrounded by healthcare professionals' is not clearly to sustain.