The notion that pregnancy can, for some women, be a time of unhappiness and depression has only recently been recognized in media and by the general public. Researchers and clinicians have begun to study antenatal depression with regards to prevalence, associated factors, and treatment. Most of the research regarding antenatal depression has been quantitative in method. Qualitative inquiry would provide the rich description of womens lived experience and meaning of antenatal depression. A hermeneutic phenomenological study was conducted with six women who scored 10, 11, or 12 on the Edinburgh Postnatal Depression Scale, indicating mild to moderate symptoms of depression. Participants were interviewed individually regarding their experiences of depression during pregnancy. Data generated in the form of transcripts were analyzed and five themes emerged: disconnection vs. new connection and/or reconnection; loss of identity vs. new identity; fatigue and illness vs. vitality and wellness; anxiety and insecurity vs. confidence and security; and sadness and hopelessness vs. joy and expectation. The overarching shared meaning of these experiences was ambivalence. Findings provided rich, thick descriptions of the lived experience and meaning of antenatal depression. Future research and implications for counselling practice are discussed.

The notion that pregnancy can, for some women, be a time of unhappiness and depression has only recently been recognized in media and by the general public. Researchers and clinicians have begun to study antenatal depression with regards to prevalence, associated factors, and treatment. Most of the research regarding antenatal depression has been quantitative in method. Qualitative inquiry would provide the rich description of womens lived experience and meaning of antenatal depression. A hermeneutic phenomenological study was conducted with six women who scored 10, 11, or 12 on the Edinburgh Postnatal Depression Scale, indicating mild to moderate symptoms of depression. Participants were interviewed individually regarding their experiences of depression during pregnancy. Data generated in the form of transcripts were analyzed and five themes emerged: disconnection vs. new connection and/or reconnection; loss of identity vs. new identity; fatigue and illness vs. vitality and wellness; anxiety and insecurity vs. confidence and security; and sadness and hopelessness vs. joy and expectation. The overarching shared meaning of these experiences was ambivalence. Findings provided rich, thick descriptions of the lived experience and meaning of antenatal depression. Future research and implications for counselling practice are discussed.

Background: A low adherence is one of the reasons for the development of drug resistant Tuberculosis. One of the identified factors connected to adherence is the relations between health care personal and patient. Nurses all over the world daily work close to the patient supporting them to achieve a high adherence to their treatment plan. Still there is an underrepresentation in a scientific view of exploring and evaluating this preformed work. Aim: The aim of this study wad to explore how the Namibian nurses experienced adherence to treatment in patients diagnosed with multidrug-resistant tuberculosis. Method: A qualitative research technic was used to collect data. The interview questions were constructed in a semi-structure with partly opened questions. The data was analysed with Graneheim and Lundman (2004) analysis model. Result: Strategies that was used by the nurses to enable a high adherence was providing information, counselling and education to the patient together with a practical support of delegating DOTS and providing the patient with medicine. There was a divided opinion on how to communicate with the patient depending on the nurse fundamental view of adherence. A doctor centred view resulted in a one way communication by informing the patient. A patient centred view of adherence resulted in a two way communication when the nurse aimed to learn about the patient own point of views. Conclusion: To enable a high adherence there has to be a two way communication which demands high communicational skills from the nurse.

Aim: The overall aim of this thesis was to acquire knowledge about whether tactile touch as a complementary method can (i) promote comfort and (ii) reduce stress reactions during care in an intensive care unit (ICU) Method: In Paper I, five nurses with a touch therapist training were interviewed about their experiences of preparation before giving tactile touch in an ICU. To analyse the meaning of preparation as a phenomenon, Giorgi’s descriptive phenomenological approach was used. In Paper II and III a randomised controlled trial was set up to investigate the effects of a five-day tactile touch intervention on patients’ oxytocin levels in arterial blood (II), on patients’ blood pressure, heart rate and blood glucose level, and on patients’ levels of anxiety, sedation and alertness (III). Forty-four patients were randomised to either an intervention group (n = 21) or a control group (n = 23). Data were analysed with non-parametric statistics. In Paper IV, six patients who had received the tactile touch intervention were interviewed to illuminate the experience of receiving tactile touch during intensive care. To gain a deeper understanding of the phenomenon and to illuminate the meaning, Ricoeur’s phenomenological hermeneutical method, developed by Lindseth and Norberg, was used. Findings: The nurses need four constituents (inner balance, unconditional respect for the patients’ integrity, a relationship with the patient characterized by reciprocal trust and a supportive environment) to be prepared and go through the transition from nurse to touch therapist (I). In the intervention study, no significant differences were shown for oxytocin levels between intervention and control group over time or within each day (II). There were significantly lower levels of anxiety for patients in the intervention group. There were no significant differences between the intervention and control groups for blood pressure, heart rate, the use of drugs, levels of sedation or blood glucose levels (III). The significance of receiving tactile touch during intensive care was described as the creation of an imagined room along with the touch therapist. In this imagined room, the patients enjoyed tactile touch and gained hope for the future (IV). Conclusion: Nurses needed internal and external balance to be prepared for providing tactile touch. Patients did not notice the surroundings as much as the nurses did. Patients enjoyed the tactile touch and experienced comfort. The impact on stress parameters were limited, except for levels of anxiety which declined significantly. The results gave some evidence for the benefit of tactile touch given to patients in intensive care. / <p>För avläggande av filosofie doktorsexamen i omvårdnad, som med</p><p>tillstånd av Fakultetsnämnden vid Fakulteten för samhälls- och livsvetenskaper vid</p><p>Karlstads universtitet framläggs till offentlig granskning fredagen den 18 april 2008 kl.10:00</p><p>M204, Högskolan i Borås.</p>

Background: In Sweden the primary reason for heart transplants is severe heart failure. Heart transplants are performed both at Sahlgrenska University hospital and at Skånes University hospital. Patient undergoing several extensive investigations before he or she will be considered for the waiting list. Primary factor for receiving a heart is first of all the patient who is in the greatest need of a new heart and the patient most suited to receive the donated heart. Previous studies show that patients feel the waiting time to be unpredictable. Aim: To describe patients’ experiences of the time before a heart transplant. Method: Qualitative content analysis was used as the analysis method and seven blogs were applied. Results: Life is seen from a new and different perspective. A common factor for patients with heart failure was the physical limitation they felt. Life stopped for a while, and a waiting to regain “life” grew strong. Family and nursing staff was thought to play an important role. To maintain a positive attitude was thought to be a criterion to manage the anticipations. Conclusion: A patient waiting for a heart transplant experiences a change in their life world. To allow proper care it is important that the nurse recognizes this change and acknowledge it.

Bakgrund: Patienter som har haft stroke kan uppleva många hinder för välbefinnande. Sjukdomen i sig kan innebära trötthet, depression och olika funktionshinder. Omgivningen kan öka illabefinnandet om den präglas av fördomar, brister i vården och problem i relationer till anhöriga. Coping innebär att hitta bemästringsstrategier som reducerar stress och illabefinnande. Syftet: Att genom självbiografier beskriva hinder och förutsättningar för coping ur ett livsvärldsperspektiv hos människor som haft en stroke. Metod: En kvalitativ innehållsanalys av självbiografier så som den beskrivs av Granheim &amp; Lundman (2012). Resultat: Fynden sorterades in under två domäner, hinder för coping och förutsättningar för coping. Det som visade sig hindra coping hos den strokedrabbade var ” Brist på följsamhet och bemötande hos personalen”, ”Att kämpa mot sjukdom som omgivning”, ”Att känna skam över sina oförmågor” samt ”Ofrivillig ensamhet och isolation”. Förutsättningar för coping är ”Förmåga till anpassning”, ” Förmåga att hantera känslor och identitet” samt ”God rehabilitering”. Vid behov har kategorierna förtydligats med hjälp av underkategorier. Slutsats: Resultatet visade på att vården kring den strokedrabbade kan bli mer gynnsam om större fokus läggs på patientens livsvärld och utifrån denna förstå vad som är hinder respektive förutsättningar för dennes coping. / Background: Patients who suffered stroke can experience different obstacles for wellbeeing. The illness itself implicates symptoms such as tiredness, depression and various functional limitations. Surroundings can increase the feeling of discomfort when based on prejudices, insufficient care and problems in relations to significant others. Coping concerns finding ways to control different situations in order to reduce stress and discomfort. Aim: To through selfbiographies describe what prevents and promotes coping seen from a lifeworldperspective from individuals who suffered from stroke. Method: Qualitative content analysis of selfbiographies as described in Granheim and Lundman (2012).Result: The findings were sorted in two domains, labeled what prevents and promotes coping. Categories that prevents coping are “Lac of compliance and caring from personnel”, “To struggle against illness and surrounding”, “To feel shame about ones incapacities” and “Unwanted loneliness and isolation”. Categories that promotes coping are “Capacity to adaption”, “Capacity to handle feelings and identity” and “Proper rehabilitation”. These are further described in subcategories. Conclusion: The result indicates that healthcare concerning the patient can be more favorable if the lifeworld of the patient is given more focus and out of that perspective understand what promotes and prevents coping of this individual.

This dissertation reports on the findings of a single, embedded, interpretive case study centered on nine teachers, supportt staff and administrators in a small, fledgling, faith-baised, independent school in a major city in Canada. Communication practices in schools are significantly impacted by the highly rational society in which they are situated as well as by the expectations often associated with traditional hierarchal roles. Independent schools, as a feature of their 'independence,' have certain freedoms to create new norms of leadeship and emancipation but also meet with greater pressures because of their increased dependency for sustainability on donations and tuition fees. They tend to be easily drawn into the competitive ideologies that exemplify a highly rationalized, free market capitalist society. A large body of literature describes the impact of excessive rationality on communicative practices. The work of Jurgen Habermas serves as foundational to the phenomena of communicative practices in this dissertation. The researcher used qualitative methods to explore participants' perspectives on the communicative practices of their school organization. The findings show participants to be vulnerable to the cultural hegemony of rationality, but anaware of that hegemonic power. However, the findings also show a desire to foster ethical and inclusive communicative practices. They also reveal a significant interplay between participants' individual theologies and their beliefs about communicative practices. The suggestions for educational change are to more readily educate both teachers and administrators regarding ethical discourse and the essential components of Ideal Speech, and for each school organization to conduct an audit of communicative practices to ensure an ongoing creation and critique of communicative norms. / Graduate

Aim The overall aim of this thesis is to create knowledge about caring and learning as an intertwining phenomenon at a Dedicated Education Unit and how it can be developed. Approach and method A lifeworld approach, based on the phenomenological philosophies foremost derived from Husserl and Merleau-Ponty was used and carried out in lifeworld interviews and with meaning-oriented analysis in accordance with reflective lifeworld research. The participants were: 13 student nurses (study I), 11 patients (study II), 8 supervisors (study III) all from the same DEU in orthopedic care and 10 managers from various DEUs (study IV). Main findings Intertwined caring and learning is most evident in genuine encounters between students and patients, supported by supervisors and managers. The intertwining is created in appealing challenges where students feel safe and ready. In the encounter with the patient they gain a sense of the whole where they can find their personal style. Patients, who feel invited to participate, could describe the encounter with students as genuine and a new dimension in nursing care. These encounters are characterized by closeness, thoroughness, accessibility, acknowledgement and sensitivity. When the encounter is less genuine, supervisors constitute an essential support for stabilizing the care.  Supervisors constantly move in order to either stay close to or stand back, adjusting to the students’ and patients’ needs. Their demanding task as reflective supervisors requires pauses in order to maintain motivation. The managers’ daily struggle in a stressful and challenging reality is influenced by them either having or taking responsibility. Differences in approaches are shown in terms of more or less involvement and commitment in caring environment and educational issues.  Conclusions Genuine encounters are characterized by the core of both caring and learning and will thereby benefit both the students and the patients. Identifying and supporting genuine encounters is necessary for students, supervisors and managers. It is time to find ways to develop a unified view of how caring and learning can be intertwined.

Parkinsons sjukdom är den näst vanligaste neurodegenerativa sjukdomen hos den äldre befolkningen. Sjukdomen påverkar den kroppsliga funktionen negativt på olika sätt och sjukdomens medicinering är betydelsefull för att kunna hantera de olika symtom som uppkommer. Personer med Parkinsons sjukdom lider risk för nedsatt livskvalitet på grund av den begränsning i livet som sjukdomen leder till. Syftet med denna studie var att belysa patientens upplevelse av att leva med Parkinsons sjukdom. Studien utfördes som en allmän litteraturstudie med en deduktiv ansats, där tio resultatartiklar användes. Resultatet kategoriserades och presenterades utifrån Preserving Self teorins fem steg och fyra övergångar. Teorin bidrog till ett brett och detaljerat resultat från resultatartiklarna och tillförde en fördjupad bild av livet med Parkinsons sjukdom. Sjuksköterskans ansvar innefattar att göra patienten delaktig i sin vård och ta tillvara de resurser som finns hos varje individ. Användningen av teorin Preserving Self kan bidra till fördjupad kunskap i vården för personer med Parkinsons sjukdom. / Parkinson's disease is the second most common neurodegenerative disease in the elderly population. The disease adversely affects the bodily function in various ways and the medication of the disease is important in order to handle the various symptoms that arise. People with Parkinson's disease are at risk of impaired quality of life due to the limitations in life that the disease causes. The purpose with this study was to highlight the patient's experience of living with Parkinson's disease. The study was conducted as a general literature study with a deductive approach, in which ten result articles were used. The result was categorized and presented based on the five stages and four transitions in the theory of Preserving Self. The theory contributed to a broad and detailed result from the resultarticles and added an in-depth picture of life with Parkinson's disease. The nurses’ responsibility includes getting the patient to participate in their care and taking advantage of the resources that exist in each individual. Using the theory of Preserving Self can contribute to in-depth knowledge in the care for people with Parkinson's disease.

The present study focuses on the phenomenology of the violent encounter, and is to be understood as the study of the violent encounter as a phenomenon, i.e. as experienced. The overall aim is to elucidate, analyse and describe violent encounters within psychiatric care as experienced by carers and patients. Moreover, the study aims at promoting the development of a phenomenological research approach in caring science in general and elucidating tacit caring knowledge in particular. The thesis includes three empirical studies and one methodological study. The research is guided by a phenomenological and lifeworld theoretical approach. Research data consist of narratives and qualitative interviews, as well as reenactment interviews with carers and patients. Data are analysed for meaning. The analysis and synthesis of meaning are aimed at openness and meaning sensitivity through a reflective attitude characterised by the intent to bridle the process of understanding. The goal of the analysis is to describe the general structure of the phenomenon and its meaning constituents. The result shows that violence and threat do not evolve in “naked” caring, characterised by encounters where carers are able to touch their patients at the same time as being touched, speaking both literally and figuratively. It is through “naked” caring and caring touch that the carers are able to reach the patients and to give undisguised invitations to genuine presence. The possibilities of touch rely on the carers’ capacity to be authentic and to genuinely wish well. Violence is on the contrary nourished by touch without caring intention, or non-touch, i.e. caring where the reciprocity of touching and being touched is missing between patients and caregivers. In the discussion, the different meanings of the violent encounter are related to the philosophy of Merleau-Ponty and Lévinas. The philosophical dimensions of touch are investigated and it is discussed how the “naked” encounter can be understood from a phenomenological ethical standpoint. The discussion focuses on the caregivers’ vulnerability and the high demands they are subjected to. It is also argued that a foundation of caring science is needed in caring practice in order to make possible a development of a caring attitude that prevents violence.