Aim: The overall aim of the present thesis was to examine, develop and evaluate patient participation in emergency department (ED) for promoting the relief of suffering for patients in care relations, from the perspective of patients and caregivers. Method: The explorative studies (I, II) were based on reflective lifeworld approach and analyzed by phenomenographic method. Data were collected from interviews by patients (9) and caregivers (11) about their conception of patient participation in ED. The methodological study (III) performed analyses and were tested for content, construct and criterion validity as well as homogeneity and stability reliability. The sample for study (III, IV) consisted of 356 patients consecutively cared for in EDs in Sweden. In the evaluating study (IV) the questionnaire Patient Participation Emergency Department (PPED) was used. The statistical methods handled were Student’s t-test, one-way ANOVA and Spearman correlation. Findings: The patients’ conception of patient participation means: being acknowledged; struggling to become involved; and having a clear space (I). The caregivers’ conceptions of patient participation can be divided into three different descriptive categories: Caregivers offer the opportunity for participation, Patients demand participation and Mutual participation (II). A 17- item questionnaire was developed. Two separate factor analyses revealed a distinct four- factor solution which was labelled: Fight for participation, Requirement for participation, Mutual participation and Participating in getting basic needs satisfied. Criterion validity presented showed 9 out of 20 correlations equal or above 0.30. Cronbach’s alpha coefficient ranged from 0.63 - 0.84 and test- retest varied between 0.59 and 0.93(III).The results show that patient participation is low in two dimensions (Fight for participation, Participation in getting basic needs satisfied), reasonable in one dimension (Mutual participation), and high in one dimension, Requirement for participation (IV). Conclusions: Participation does occur on occasion when the circumstances are right despite international and national guidelines that lay down the need for patient participation. Patient participation in EDs is perceived when patients are in contact with caregivers and there is space for collaboration in situations of consistency. However, patient participation cannot be offered in a one-sided caring action. In collaboration patient participation contributes to the relief of suffering in the process of health and patients participate when they are allowed to be the point of departure for caring. However, the results point to a lack of strategy for patient participation and for increased patient participation to take place improvements in external organization requirements are required. The results indicate an amplified clarity in how patient participation can be understood for EDs, in education and community and a scientific tested instrument has made it possible to evaluate patient participation.

Dental involvement with oral cancer patients during their treatment and rehabilitation can be long and intense. How can dental personnel better understand their role in the treatment of these patients? How does treatment affect the patients and their spouses? In searching for answers, the theories of phenomenography, phenomenology and hermeneutics are used to describe and interpret the experiences of the hospital dental treatment teams, oral cancer patients, and their spouses. Study I reveals that hospital dental treatment teams perceive the encounter with head and neck cancer patients in three qualitatively different ways; as an act of caring, as a serious and responsible task, and as an overwhelming emotional situation, indicating that they are not always able to lean on education and professional training in dealing with situations with strong emotional impact. Study II gives insight into the lifeworld of oral cancer patients, and how the patient becomes embodied in a mouth that is increasingly `uncanny´, as it slowly ceases to function normally. Study III shows that oral cancer puts a hold on the lifeworld of the patients’ spouses which can be described as `living in a state of suspension´. These findings suggest that the support needs of patients and spouses appear to be greatest at treatment end, when, upon returning home, they are faced with the accumulated impact of the patients’ sickness and treatment. Study IV gives insight into what it may mean to live with the consequences of oral cancer, revealing a silent physical, emotional and existential struggle to adjust to a changed way of living. This thesis raises the question if todays’ organisation of oral cancer care can meet the varying emotional and existential needs of treatment teams, patients and spouses that were brought to light.

Äldres rädsla för att bli utsatt för brott är ett relativt outforskat område. Aktuell forskning om äldres rädsla sammanställs genom statistik för hur många äldre som känner rädsla, men det fattas ett berättande perspektiv där man lyfter fram vad de äldre har att säga om sina erfarenheter och upplevelser av rädsla för att bli utsatt för brott. Syftet för denna studie är att undersöka vad äldre personer har att säga om fenomenet rädsla för att bli utsatt för brott och ta reda på hur det ser ut och påverkar deras vardag.Studien har en fenomenologisk ansats med livsvärldsteorin som utgångspunkt. Datainsamlingen har skett genom öppna intervjuer. Resultatet visar att fenomenet äldres rädsla för att bli utsatt för brott visar sig som att vara riskanalytiskt medveten. Detta framgår i följande konstituenter: (i) att utveckla strategier för eventuell utsatthet av brott, (ii) upplevelse av oro, (iii) upplevelse av rädsla, (iv) rationellt tänkande kring brott och (v) tidigare erfarenheter av utsatthet för brott. Dessa konstituenter bildar fenomenet som i sin tur är den upplevelse som visar sig i informanternas livsvärldar.De kunskaper som studien bidrar med kan användas för fortsatt arbete med förebyggande åtgärder för brott relaterat till äldre och för att göra de äldres känsla av sin tillvaro tryggare. / Elderly people's fear of becoming a victim of crime is a relatively unexplored area. Current research on elderly people’s fear is compiled by statistics on how many elderly people who feel fear. A narrative perspective where one highlights what the elderly people have to say about their experience for fear of becoming a victim of crime is missing. The purpose of this study is to analyze what elderly people have to say about the phenomenon “fear of becoming a victim of crime” and ascertain how it looks and how it affects their everyday life.The study has a phenomenological approach with life-world theory as a starting point. The data collection was made through open interviews. The results show that the phenomenon “elderly peoples fear of becoming a victim of crime” proves to be a risk analytical conscious. This is shown in the following constituents: (i) to develop strategies for eventual exploitation of crime, (ii) the experience of anxiety, (iii) the experience of fear, (iv) rational thinking about crimes and (v) the previous experience of victimization. These constituents are forming the phenomenon, which in turn is the experience that is reflected in the informant’s life worlds.The knowledge this study contributes with can be used for continued work with prevention of crimes related to the elderly and to make their sense of their lives safer.

The extensive suffering related to a complex life situation with bipolar disorder and the reported difference between care needs and the needs that are actually met implicates that there are still questions about management of life with bipolar disorder that need to be answered. The present study therefore aims to describe the meaning of the conditions that enable a good life with bipolar disorder. Ten persons, six women and four men, (aged 30 – 61), diagnosed with bipolar disorder were interviewed. A reflective lifeworld perspective based on phenomenological philosophy was used. The findings present the essential meaning of the conditions that enable a good life with bipolar disorder as a dependence that empowers, which is further described by its constituents: “turning the course of life”, “protecting oneself from running out of energy”, “being needed”, “being oneself through reliable others”, “personal landmarks for navigating through life”. A voluntary chosen dependence, as described in the present study, is a new approach of care that enables a good life with bipolar disorder, while enhancing own power, freedom and control. The conditions that enable a good life with bipolar disorder are more than separate supporting measures. Therefore a holistic perspective is preferable while providing care for individuals with bipolar disorder.

Bakgrund: Varje år könsstympas fler än 2 miljoner kvinnor. Traditionen att könsstympa kvinnor går så långt tillbaka i historien att ingen historiker i dagsläget kan säga exakt hur, var och varför denna sedvänja uppstod. Det förekommer i ett trettiotal länder. Ingreppet sker ofta utan smärtlindring, sterila instrument och kompetent personal. I Sverige är kvinnlig könsstympning brottsligt, lagen gäller alla svenska medborgare oavsett om det sker inom Sveriges gränser eller utanför. Antalet könsstympade kvinnor i Sverige har ökat i takt med ökad invandring. Kvinnlig könsstympning kan ses som ett övergrepp och kan ge konsekvenser för kvinnor livet ut. Syfte: Syftet var att belysa de fysiska, psykiska och sociala konsekvenserna för kvinnor som genomgått könsstympning. Metod: En litteraturstudie genomfördes enligt Forsberg (2006) och startade med sökningar i databaserna Cinahl och PubMed. Sju kvantitativa och fyra kvalitativa artiklar valdes ut för analys. Resultat: De fysiska konsekvenserna rörde främst miktion, menstruation och sexuellt samliv. Känslomässiga trauman och en känsla av förlust dominerade de psykiska konsekvenserna. Gällande de sociala konsekvenserna berördes kvinnornas identitet till stor del samt deras upplevelser av hur västerlänningar ser på dem. Resultatet visar på övervägande negativa fysiska, psykiska och sociala konsekvenser. Även positiva aspekter har framkommit. Diskussion: I resultatet framgick tre större teman som var gemensamt för de fysiska, psykiska och sociala konsekvenserna. Dessa var kulturkrock, sociala påtryckningar och individ. De kan bidra till att förbättra omvårdnaden av kvinnor som genomgått könsstympning. Diskussionen inspireras av teorin Theory of cultural marginality där fokus ligger på att förklara människors reaktioner då två kulturer kolliderar. / Background: Each year, about 2 million women undergoes genital mutilation. The tradition of genital mutilation of women goes so far back in history that no historians in our time can say exactly how, where and why this practice occurred. The only thing we know is that the practice of female genital mutilation is performed in about thirty countries. The surgery is often done without analgesia, sterile instruments and medically skilled personnel. In Sweden, genital mutilation is a crime and the law applies to all Swedish citizens, regardless of whether it occurs within Sweden's borders or outside. The number of genitally mutilated women in Sweden has increased in line with increased immigration. Genital mutilation can be seen as an assault and may have consequences for women throughout their lives. Purpose: The purpose was to illuminate the physical, psychological and social consequences for women who have undergone genital mutilation. Methods: A literature review was conducted in accordance to Forsberg (2006). The search started out by using two databases, Cinahl and PubMed. Seven quantitative and four qualitative articles were selected for analysis. Results: The physical consequences were related to urination, menstruation and sexual intimacy. Emotional trauma and a sense of loss dominated the psychological consequences. The two largest social consequences that were found were the women's identity and their experiences of how westerners experience them. The result shows predominantly negative physical, psychological and social consequences, although positive aspects also emerged. Discussion: The results showed three major themes that were common to the physical, psychological and social consequences. These were culture clash, social pressures and individuals. They can help to improve the care of women who have undergone genital mutilation. The discussion was inspired by the theory "Theory of cultural marginality" where the focus is on explaining people's reactions when two cultures collide.

This study describes and analyses understanding ‘illness’ among clients and leaders of the spiritual tradition Candomblé in Rio de Janeiro. The study focuses on the individuals’ narratives of illness and of healing rituals within the cult. Particular attention is given to the consultation ritual called jogo de búzios, which is one of the main practices of finding the reason for the illness as well as its cure. The emphasis in this study is on the necessity to look at medical pluralism, the socio-individual context of illness and narrativity as an intersubjective practice. The conclusion is reached that illness within Candomblé ideology can be understood as disequilibrium in a person’s lifeworld. The individual is approached from within the plurimedical context of both biomedical and Candomblé healing tradition in Rio. Here it is argued that the person creates meaning of the illness in relation to different aspects of his lifeworld. The individual’s lifeworld includes the urban context of Rio de Janeiro; therefore a brief discussion is developed about how this context influences the individual meaning production of the illness. The Candomblé house is described with its social structure and other elements that are important for understanding how the cult might work for the clients as an alternative and/or complementary medical treatment. The study progressively introduces and analyses the lifestories of the individuals that approach the Candomblé cult in order to seek treatment. It also is concerned with stories of the Candomblé leaders and their view on the phenomenology of the Body, the Self and the social milieu of the person. Finally, the study emphasises the importance of studies that focus on the individual’s interpretation of the relations between the Self and the Body, and the individual’s understanding of medical knowledge and practice.

Author: Elisabeth Wahlberg   Title: “…I’ll just get mum to help me” About Young Adults’ Strategies for Coping with Reading and Writing Difficulties in Daily Life     This study investigated how seven young adults, who during senior high school underwent a syllable based intervention due to reading and writing difficulties, developed their literacy skills, and what strategies they used to try to overcome reading and writing problems, whether at work, during studies or in their leisure time. The period from when the participants had left school ranged between three and eight years. Qualitative as well as quantitative data was compiled for the study. Qualitative data consisted of  semistructured interviews and quantitative data of tests performed before the intervention and on two occasions after, in order to compare results over time. The study was a longitudinal case study with a phenomenological lifeworld approach and looked to increase awareness of the realities of living with reading and writing difficulties. It analysed how the participants dealt with their problems and what strategies they employed, in order to overcome them. Study results showed that even as participants improved their literacy skills compared to pre-intervention, reading and writing remained an issue. All participants were forced to adjust to the fact that they were affected in their daily lives, whether in choice of career or further education, or more everyday tasks involving reading and writing and also the inclination to read for pleasure. They avoided to expose their shortcomings if at all possible. Still, the participants all strived to tackle their reading and writing problems by applying elements from the syllable based intervention in conjunction with inventing individual strategies.

Background: Breast cancer is one of the most common types of cancer in the world and it usually affects elderly women. However, there are between 600-700 cases per year in Sweden where women under the age of 45 are diagnosed. Removal of the breast or part of the breast, hair loss, fatigue and nausea as a result of the breast cancer treatment has an emotional and physical impact on the women’s lifeworld. The nurse should build a relationship with the women to identify and meet their needs.  Aim: To describe younger women’s experiences of getting a breast cancer diagnosis and life afterwards. Method: Four biographical books were analyzed to match the aim of the study. Result: The findings were that the women experience similar thoughts and feelings when it comes to living with a cancer diagnosis. Feelings such as fear, anger and distress were expressed in the biographies. To be able to fight against the disease the women highlighted the importance of support from family members and the medical staff. Conclusion: The women’s describes both physical and mental changes due to treatment, a strong influence on the woman’s lifeworld. It is therefore important that the nurse support, comfort and assist the patient during the entire course of the disease. It might help the woman to find bright spots in life and maintain hope for the future.

Abstrakt Bakgrund: Det råder idag en brist på specialistutbildade sjuksköterskor, och många avslutar sin yrkeskarriär inom hälso- och sjukvården p.g.a. ökade stressnivåer. Ett sätt att komma tillrätta med detta kan vara att använda mentorskap för den nyutexaminerade. Det är därför nödvändigt att klarlägga vilka förutsättningar som krävs och även undersöka hur den nyutexaminerade specialistsjuksköterskan synes utvecklas genom mentorskap. Syfte: Syftet med studien är att utifrån den erfarna specialistsjuksköterskans uppfattning beskriva om och hur mentorskapet synes utveckla den nyutexaminerade specialistsjuksköterskan, och vilka förutsättningar som upplevs viktiga för detta mentorskap. Metod: En fallstudie medelst en djupintervju genomfördes med en fenomenografisk ansats, för att få fram den uppfattning av mentorskap som föreligger hos den erfarna specialistsjuksköterskan. Resultat: I resultatet framkommer vikten av att verksamhetsansvariga erbjuder nödvändiga förutsättningar i form av tid, utbildning och kompetens. Genom en ökad socialisering stärks yrkesprofessionen, samtidigt som en lärande miljö skapas i den gemensamma reflektionen. Konklusion: Erfarna specialistsjuksköterskor kan medverka till att den nyutexaminerade på ett så effektivt sätt som möjligt ges möjlighet att både formulera sin nya yrkesprofession och medverka till den socialisering som krävs för att komma in i arbetsgruppen. Det ses också en positiv bieffekt i form av förbättringsarbete utav mentorskapet. / Background: There is current shortage of specialized nurses, and many end their career in health care due to increased stress levels. One way to overcome this may be the use of mentoring for new graduates. In purpose of developing a mentoring program, there is a need to clarify the conditions required for it and examining how the professional role is developed through mentoring. Purpose: The purpose of this study is to describe experienced specialist nurse's perception if and how mentoring is developing the graduate specialist nurse, and the conditions that are perceived important for this mentoring. Method: A single case study using a deep interview was conducted with a phenomenographic approach, in order to explore the experience of mentoring from the view of the advanced specialist nurse. Results: The result shows the importance of the management providing the necessary conditions in terms of time, training and competence. In the socialization process the strengthening of the professional role was experienced, while providing a learning environment is created in the joint reflection. Conclusion: Experienced specialist nurses can assist the new graduate in the most efficient manner possible given to formulate the new role as a specialist educated nurse and also contribute to the socialization needed to get into the workgroup. A side benefit in terms of quality improvement is also seen out of the mentorship.

Acute myocardial infarction is a serious diagnosis. Both the patient and the loved ones experience an immediate uncertainty. To be able to emotionally support the patient´s spouse, the nurse in the coronary care unit must be prepared to also encounter the world of the spouse. The aim of this study was from a nursing perspective to illuminate how life was experienced during the first two months by the spouse of someone, who was stricken by a first time acute myocardial infarction. Interviews with six spouses were conducted. The methodological approach was phenomenological-hermeneutic, based on the French philosopher Paul Riceour. The result of the qualitative text analysis showed four themes: To lose one´s foothold, To be exposed to the medical and nursing staff, To get a changed relationship to one´s partner, To wish to make the most of one´s life. The first theme highlighted the spouse’s strong feelings of uncertainty concerning the outcome of the patient. The second theme showed the spouse’s confidence in the medical care. It also showed the spouse’s sense of being insulted by the nurses, who did not acknowledge the spouses´ need of obtaining information and emotional support. The third theme demonstrated how the partner cared for and felt responsible for observing the former patient´s health condition. The fourth theme showed that the spouse realized that life has to come to an end and therefore wanted to realize his/her plans for the future before it was too late. The findings from this study emphasize the importance of the medical and nursing staff to show interest in the spouses´ experiences. Thereby the spouses can experience a support in congruence with their needs, and their life situation might thereby be improved. It would be of great interest to study how nurses regard the spouses´ life situation during the patients´ stay in hospital. Further research could also highlight which factors could minimize the sufferings of partners to seriously sick patients, regardless of the patients´ diagnosis.