Bakgrund: Diabetes mellitus typ 2 är en kronisk sjukdom som blir allt vanligare i samhället. Under 2019 uppskattades 463 miljoner vuxna leva med diagnosen och antalet förväntas att stiga. Komplikationer av sjukdomen är många men de allvarligaste är hyperglykemi och kardiovaskulära förändringar. Vården utgörs till stor del av egenvårdsaktiviteter för att främja fysisk aktivitet, hälsosam vikt och rökstopp. Egenvård innebär ett partnerskap med sjuksköterskan vilket innebär att patienten själv måste aktivt delta. Syfte: Syftet med denna översiktsstudie var att belysa sjuksköterskors erfarenheter patientutbildning inom diabetes typ 2. Metod: Denna studie är en översiktsstudie med kvalitativ design baserad på tio granskade studier. Studierna analyserades med hjälp av innehållsanalys för att identifiera kategorier och underkategorier som svarade till syftet. Resultat: Analysen resulterade i två huvudkategorier: Sjuksköterskans upplevelser av barriärer och Sjuksköterskans upplevelser av sin identitet inom patientutbildningen. Detta innebär att det finns olika roller som sjuksköterskan måste tillämpa, vilket kan leda till osäkerhet. Sjuksköterskorna upplevde i vissa sammanhang även en otillräcklighet. Sjuksköterskorna upplevde även att det fanns barriärer av olika slag som hindrade en adekvat patientutbildning Konklusion: Det fanns en vilja och en insikt om att egenvårdsteori och individanpassning var något av stor vikt i patientutbildningen. Samtidigt uppmärksammades olika hinder strukturellt och personligt för att anpassa sin roll efter dessa principer. / Background: Diabetes mellitus type 2 is a chronic disease that is becoming more common in society. In 2019, 463 million adults were estimated to live with the diagnosis and the figure is expected to rise. Complications of the disease are many but the most serious are hyperglycemia and cardiovascular changes. The care consists largely of self-care activities to promote physical activity, healthy weight and smoking cessation. Self-care involves a partnership with the nurse, which means that the patient himself must actively participate. Purpose: The purpose of this literature review study was to illuminate nurses' experiences patient education in type 2 diabetes. Method: This study is a review study with a qualitative design based on ten studies. The studies were analyzed using content analysis to identify categories and subcategories that corresponded to the purpose. Results: The analysis resulted in two main categories: Nurse's experiences of barriers and Nurse's experiences of her identity in patient education. This means that there are different roles that the nurse must play, which can lead to uncertainty. In some contexts, the nurses also experienced an inadequacy. Conclusion: The nurses also felt that there were barriers of various kinds that prevented adequate patient education. At the same time, various obstacles were noted structurally and personally to adapt their role to these principles.

Bakgrund: Bröstcancer är den vanligaste cancersjukdomen bland kvinnor och ca 8000 diagnostiseras varje år. Upplevelsen är individuell men generellt drabbas kvinnorna psykologiskt i dubbel bemärkelse. Det handlar dels om ovissheten angående sjukdomen och död, men också om kvinnlighet och utseende. Syfte: Syftet med denna litteraturstudie var att beskriva hur kvinnor hanterar upplevelsen av att leva med bröstcancer. Metod: Litteraturstudie med deskriptiv design som bygger på 12 kvalitativa vetenskapliga artiklar. Databasen Pubmed via Medline har använts. Huvudresultat: Resultatet visade att stöd från familj, vänner och utomstående samt att finna någon slags mening med sin diagnos gav kvinnorna mest kraft för att hantera sin situation. Att distrahera sig själv genom att fokusera på andra saker, fortsätta som vanligt eller planera inför framtiden trots sjukdom beskrevs även som sätt att försöka klara sig igenom den svåra tiden. Kvinnor som trodde på en Gud och fann tröst i det förekom upprepade gånger. I de flesta av studierna berättar kvinnorna om att de har fått en ny syn på livet och uppskattar det på ett annat sätt jämfört med innan de fick diagnosen. Slutsats: Bröstcancer är den vanligaste cancersjukdomen hos kvinnor. Stöd från anhöriga och utomstående, förändra upplevelsen samt att fortsätta som innan diagnostisering var det vanligaste strategierna för att hantera upplevelsen på. Religion hjälpte många kvinnor att acceptera sin sjukdom. Genom att erhålla kunskap om detta kan sjuksköterskan bemöta dessa kvinnor med en bättre förståelse för hur upplevelsen av en bröstcancerdiagnos och efterföljande behandlingar hanteras. / Background: Breast cancer is the most common cancer disease among women and about 8,000 are diagnosed each year. The experience is individual but in general women are psychologically affected in a double sense. It is partly about the uncertainty about the illness and death, but also about femininity and appearance. Aim: The aim of this literature study was to describe how women deal with the experience of living with breast cancer. Method: Literature study with descriptive design based on 12 scientific articles with a qualitative approach. Data collection has been carried out via PubMed. Main results: The result showed that support from family, friends and outsiders as well as finding some kind of meaning with their diagnosis gave women the most power to deal with their situation. Distracting oneself by focusing on other things, continuing as usual, or planning for the future despite illness was also described as a way to try to make it through the difficult times. Women who believed in a God and found comfort in that repeatedly appeared. In most of the studies, women report that they have been given a new outlook on life and appreciate it in a different way compared to before they were diagnosed. Conclusion: Breast cancer is the most common cancer disease among women. Support from relatives and others, changing the experience and continuing as before diagnosis was the most common strategies used to manage the experience. Religion helped many women to accept their illness. By gaining knowledge of this the nurse can respond to these women with a better understanding of how the experience of a breast cancer diagnosis and subsequent treatments are handled.

Bakgrund: Inflammatorisk tarmsjukdom (IBD) är ett samlingsnamn för de kroniska tarmsjukdomarna Crohns sjukdom (CD) och Ulcerös kolit (UK). Det gemensamma för de två sjukdomarna är att de löper i skov med försämringsperioder och långa besvärsfria perioder samt att de drabbar relativt unga personer. Det är viktigt att sjuksköterskan kan stödja dessa individer genom evidensbaserad och personcentrerad vård för att kunna ge en så god omvårdnad som möjligt.  Syfte: Beskriva individers upplevelse av att leva med inflammatorisk tarmsjukdom Metod: En litteraturöversikt valdes som metod. Artikelsökningen genomfördes i databaserna CINAHL Complete och PubMed. De begränsningar som gjordes i databassökningarna var vetenskapliga originalartiklar, skrivna på engelska, genomgått peer-review och publicerade mellan 2009-2019. Totalt inkluderades elva artiklar i resultatet, av dessa var tio artiklar kvalitativa och en var kvantitativ. Resultat: Resultatet visade att individerna upplevde att sjukdomen påverkade deras arbetsliv, sociala liv, känslor och identitet. Deras möte med hälso- och sjukvården påverkade personernas förtroende för vården samt deras vilja att söka vård framöver. Det visades även att personer med inflammatorisk tarmsjukdom genomgick en transitionsperiod efter deras diagnos. Hur personerna upplevde att leva med IBD påverkades av om de för tillfället befann sig i ett skov eller nyligen fått diagnosen. De personer som befann sig i ett skov eller nyligen fått diagnosen hade en övervägande negativ syn.  Diskussion: Resultatet diskuterades utifrån Katie Erikssons teori om lidande och hälsa. Författarna resonerade om individernas negativa påverkan kunde kopplas till stigman av sjukdomen. De diskuterade även angående den långsiktiga påverkan av frånvaron från arbetet och sociala sammanhang. Författarna fann i resultatet att individer med IBD upplevde sjukdomen olika i sin vardag beroende på hur länge de haft sjukdomen och vilken inställning de har gentemot sin IBD. Därmed bör vården anpassas efter de individuella behoven för att säkerställa att insatserna främjar hälsan. / Background: Inflammatory bowel disease (IBD) is a chronic illness that includes Crohn´s disease (CD) and ulcerative colitis (UK). Both diseases have in common that they have relapse and periods with improvement. The diseases effects relatively young people. It is important that the nurse can support these individuals through evidence based and person-centred care in order to provide the best possible care. Aim: Describe individuals experiences of living with inflammatory bowel disease  Method: A literature review was chosen as the method. The article search was carried out in the databases CINAHL complete and PubMed. The limitations made in the database searches were scientific original articles, written in English, peer-reviewed and published over the last ten years. A total of eleven articles was included in the result, of which ten were of qualitative design and one was quantitative design. Results: The results showed that the individuals experienced that the disease affected their working life, social life, feelings and identity. Their meeting with healthcare services affected their trust in the care and their willingness to seek care in the future. It was also shown that people with inflammatory bowel disease underwent a transition period after the diagnosis. How the individuals experienced living with IBD was affected by whether they were relapsing or in remission. People currently in a relapse had a more negative view of the disease.  Discussion: The result was discussed based on Katie Eriksson´s theory of suffering and health. The authors reasoned if the negative impact of the individuals could be linked to the stigma and shame of the disease. They also discussed the long-term impact of the absence from work and social activities. The authors found in the results that individuals with IBD experienced the disease differently in their daily lives depending on how long they had the disease and what attitude they had towards their IBD. The care should be adapted to the individual needs to ensure that the efforts promotes health.

These four stories are stories about life. The central characters are at a time in their lives when decisions become crucial and they have to act or become lost. Each of the dominant characters has experienced something in life that was beyond their control and they haven't recovered. These stories bring out and explore their recoveries. They are stories of rediscoveries of the self. In the story Gray, Margaret, is not in control of her life. She has had the trauma of losing her only daughter, and there is the intervention of a family friend who has only greed at heart. Margaret and her husband cannot cope and their situation is rapidly moving out of their control. Margaret discovers inner strength, and in her own subtle way, conveys this to her husband. She rebounds from the death of her daughter by becoming stronger herself. In the end, she has found peace within herself and the grief will take a more natural course. The characters in Revenge, parody people in repressed situations. The three women, a farce on three fairy tales, are out for revenge. They comically plot the deaths of the men who have repressed them. Their feminist attitudes lead them through adventures until, at last, they are free. Red Hood, Locks, and Beauty represent women who when bonded together become strong. They gain support from one another and then have the courage to act out their plans. Monica in A Strangled Cry, is not quite so strong. She has a history of problems. These problems are being compounded without her knowledge. She is repressed and controlled by Jeff, her doctor. She finally reaches a point where she knows that she either has to break free of the downward spiral of her life or give in to it forever. She cannot do it alone, however, and she has the help of her brother zack for her final escape. Finally, in Nine Lives, Katherine is in a relationship which is keeping her repressed. She tries to escape but cannot seem to. Finally she relies on help from her mother and her mother's attorney to help her flee from her abusive husband. She achieves her freedom after a long and trying escape. All four of the stories are a brief outlook on a side of life. The main characters have to make decisions which will affect the rest of their lives. The decisions are not always completely conscious or deliberate, but the results are consequential.

Not a lot of research has been done on the middle age years despite this being a pivotal time for adults. Women at this stage of their lives undergo many changes such as perimenopause to complete menopause, having to take care of aging parents, and losing a spouse. Additionally, women tend to seek other women for help and support and form a community that is bound by common concerns and experiences. This qualitative case study explored how a group of middle-aged women experienced life changing events and how their faith and community enabled them to overcome the challenges those incidents brought to their lives. This study also looked into other factors that contributed to their being able to confront and overcome the challenges from those experiences . Thirteen women from one faith community in Manila, Philippines were interviewed individually to find answers to the following research questions: 1. How do middle-aged women describe the life-changing event they have experienced? 2. What approach(es) do middle-aged women take when they are undergoing a life changing event so they can cope with the situation they are experiencing? 3. In what ways does the faith community help the women in the group cope with the life changing event? 4. What other factors may influence these women’s ability to copy with the life changing events they face? Another five women from a different faith community were engaged in a focus group discussion to corroborate the following findings from the individual interviews: 1. Unanticipated events were often challenging and devastating and had a major impact on the lives of these middle-aged women. Additionally, those events did not happen in isolation but, rather, led to other events that were even more lifechanging. 2. When confronted with an unexpected, life-changing event, these middle-aged women were faced with a myriad of feelings and emotions that they examined, evaluated and shared with people they trusted. They also handled their own situation by seeking help from others. 3. Support was a critical element in the ability of these middle-aged women to confront and overcome a devastating transition event. Their faith community offered various types of support during most of the events. 4. The faith of middle-aged women was a significant factor in confronting and overcoming those unexpected events. The women believed their faith made them stronger and made them determined to prevail over the circumstances of the event. This study concluded the following: 1. Middle-aged women go through a variety of highly impactful transitions and their reactions to the event vary from one woman to another depending on the context in which it occurs and the impact on the woman’s life. The manner in which a woman in this age range adapts to the transition event will predict how they are able to cope with the impact of the event on their lives. 2. Support provided by the network built by a woman over her lifetime is essential in confronting and overcoming challenges posed by a transition event. Support can come in different forms and is appreciated by the women. That support enables them to confront, overcome and adapt to the transition event. 3. The women’s religious beliefs are critical to recovery and growth of these middle-aged women and sustain them as they are adapting to their transition events.

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Do people become more optimistic about future adjustment to negative life events after rumination? Past research using a "top of the head" paradigm indicates that people estimate they would adjust more poorly for severe events and better for mild negative events than their peers. Selective focus (i.e., differential accessibility of information about assets and liabilities for coping) has been provided as an explanation for this effect, which is counter to research on "optimistic bias". Martin and Tesser's (1989) rumination model was applied to beliefs about one's comparative adjustment to negative life events. One hundred twenty undergraduate subjects were asked to imagine experiencing a Severe (HIV+) or Mild (Herpes) negative event at some future time, then to designate items on a reaction time task as either an Asset or Liability in coping with the event. The reaction time task and subsequent comparative adjustment ratings were made either immediately, after a delay that allowed for rumination, or after a delay without an opportunity for rumination. A thought-listing analysis of the audiotaped ruminations revealed that, as predicted, subjects became more optimistic over time. They initially discussed liabilities in coping with the Severe event but gradually considered assets. Comparative adjustment ratings for the Severe event were not significantly different than for the Mild event, even in the Rumination Absent condition. It was suggested that temporarily making assets for coping accessible through the reaction time task had the same effect on comparative adjustment ratings as did problem-solving through rumination. The reaction time data provided convergent evidence regarding selective focus and complimented a thought-listing paradigm used in previous studies. / Master of Science

The present study examined a social marketing approach to a health promotion program in stress management education that combined various aspects of large scale mass-market campaigns and individually tailored interventions. The study was conducted in two major phases using two groups from the main population of retired university faculty members. The intervention was a series of stress management seminars which was presented in each phase. Program evaluation took place at several intervals throughout the study. The first phase of the study served to assess the retirees' needs and to develop the program content and delivery style by using the target population's administrative committee. This committee became the focus group. The presentation of the stress management seminars to the focus group was specifically tailored to the group through frequent interactions and participation by the group members. On evaluation, the program was shown to be effective on a number of dimensions, but it was also labor intensive. A second phase was conducted on a larger sample from the target population of retirees. The sample was found to be equivalent to the focus group on demographic variables, stress levels, and stress management practices. This phase utilized the same program content that was developed in the first phase, but further examined program delivery. Two styles of program delivery were compared. The first was a didactic, lecture-style frequently used in large scale educational campaigns; the second was an interactive, discussion style, used more frequently in individual interventions. Overall, the program participants from both phases improved in their abilities to identify their stress symptoms, stress management strategies that they felt they would use, and increased their levels of perceived control over their stress. Factor analysis was one method used to evaluate program effectiveness and to replicate the factor structure of coping strategies from another study. The utility of factor analysis as an assessment procedure was developed and supported. No major significant differences between delivery styles were found. Thus, indirect tailoring of the program for the target population through the representative focus group was as effective as directly tailoring the program with the target population. Both the interactive and didactic approaches can be integrated into a single educational program to obtain an optimal combination of cost-effectiveness and informativeness. Once the program content was developed through the intensive process of tailoring in the first phase, the more efficient didactic delivery style could be used equally successfully with a matched population. Clinically, the study served as a cost-effective prototype of a stress-management education program for the mass-market. / Ph. D.

The purpose of this research was to examine specific coping methods used by the elderly as they adjust to the environment of a long-term care facility, and to examine the correlations between these coping methods and levels of depressive symptomatology.