Bakgrund: I Sverige drabbas ca 10 000 personer årligen av afasi som beror på skador i språkcentrum i hjärnan. Afasi innebär att den drabbade begränsas i sin förmåga att uttrycka sig, förstå eller formulera sig meningsfullt. Sjuksköterskor möter personer med afasi i olika kontexter och behöver kunskap om olika sätt att kommunicera för att främja autonomi och delaktighet. Syfte: Syftet var att belysa sjuksköterskans erfarenheter av kommunikation med personer med afasi i sluten- och öppenvård.  Metod: En litteraturöversikt med kvalitativ metod och induktiv ansats utfördes som baserades på elva vetenskapliga artiklar. Artiklarna analyserades utifrån Fribergs femstegs modell (Friberg, 2022). Resultat: I resultatet framkommer tre kategorier som innehåller sjuksköterskors erfarenheter av kommunikation med personer med afasi. Dessa är: Organisatoriska och miljömässigt inflytande på kommunikation, främjande faktorer och barriärer för kommunikation samt sjuksköterskans förhållningssätt i mötet med personer med afasi.  Slutsats: Osäkerhet i kommunikation med personer med afasi kan minskas med rätt resurser och förhållningssätt. Vissa kommunikationsverktyg är användbara men framför allt är utrymme i tid och arbetsmiljöfaktorer avgörande för lyckad kommunikation. Att våga stanna kvar är viktigt för att upprätta en relation som främjar kommunikationen mellan sjuksköterskan och personen med afasi. / Background: In Sweden, about 10 000 people suffer from aphasia every year, which is due to damage to the language center in the brain. Aphasia means that the sufferer is limited in their ability to express themselves, understand or formulate themselves meaningfully. Nurses meet people with aphasia in different contexts and need knowledge of different ways of communicating to promote autonomy and participation. Aim: The aim was to illustrate the nurse´s experiences of communication with people with aphasia in both in- and outpatient care.  Method: A literature review with a qualitative method and inductive approach was performed which was based on eleven scientific articles. The articles were analyzed based on Friberg´s five step model (Friberg, 2022).  Results: The result show three categories that contain nurses experience of communication with people with aphasia. These are: Organizational and environmental influence on communication, promoting factors and barriers to communication and the nurse´s approach in meeting people with aphasia. Conclusion: Uncertainty in communication with people with aphasia can be reduced with the right resources and approach. Some communication tools are useful, but above all, space in time and work environment are factors that are decisive for successful communication. Dare to stay with the person is important to establish a relationship that promotes communication between the nurse and the person with aphasia.

Bakgrund: ALS är en obotlig progressiv sjukdom med komplex symtombild, som leder till döden inom tre till fem år. Närstående har en central roll i den utmanande vården av en person med ALS, därför behöver sjuksköterskor få en fördjupad kunskap kring närståendes upplevelser av att vårda en person med ALS, för att uppnå en god palliativ vård. Syfte: Syftet var att belysa närståendes upplevelser av att vårda en person med ALS. Metod: Litteraturöversikt med tematisk analys, baserad på resultatet från 13 kvalitativa studier och den kvalitativa delen av resultatet i tre mixade studier, totalt 16 studier. Resultat: Närståendes upplevelser beskrivs i fem teman. Förändrade relationer och roller belyser omfördelning av roller, känslor av identitetsförlust och otillräcklighet. Att behöva ta ansvar och fatta beslut speglar upplevelser av att vara i beredskap dygnet runt och att ställas inför svåra beslut. Den alltmer utmanade kommunikationen handlar om kommunikationssvårigheter och att vara tvungen att utveckla nya former för kommunikation. Strategier för att hantera det förändrade livet innefattar närståendes egna strategier för att hantera vården av en person med ALS. Det sista temat Tilltagande hjälpbehov illustrerar behov av information, medicinsktekniska hjälpmedel, psykosocialt stöd och en kontaktperson som samordnare av vården. I resultatdiskussionen relateras resultatet till Andersheds och Ternestedts teori: ”delaktighet i ljuset och delaktighet i mörkret”.  Slutsats: Resultatet visar att ”delaktighet i ljuset och delaktighet i mörkret” är stark associerat med vilket stöd och hjälp närstående har tillgång till. Att tidigt integrera palliativ vård, där specialistsjuksköterskan kan fungerar som kontaktperson och samordnare av vården, ökar möjligheten för närståendes ”delaktighet i ljuset” och ökar förutsättningar för en bättre hälsa. / Background: ALS (Amyotrophic Lateral Sclerosis) is a progressive and incurable disease with complex symptom, which often leads to death within three to five years. In order to provide good palliative care, nurses need to gain an in-depth understanding of the experiences of the next of kin in caring for a person with ALS, as family caregivers play an important role in the challenging care of a person with ALS. Aim: The aim  was to highlight family caregivers’ experiences of caring for a person with ALS. Method: A literature review was conducted using thematic analysis to analyze the results of 13 qualitative studies, along with the qualitative part of three mixed studies, totaling 16 studies. Results: There are five themes that describe the experiences of family caregiver. Changing relationships and roles highlights how roles are redistributed, creating feelings of identity loss and inadequacy. Having to take responsibility and make decisions reflects experiences of being on call around the clock and facing difficult decisions. The increasingly challenging communication is about communication difficulties and the need to develop new forms of communication. Strategies to cope with an altered life situation describes family caregiver ‘own strategies for managing the care of a person with ALS. The final theme, Increasing need for assistance, highlights the importance of having access to information, medical aids, psychosocial support, and a contact person who coordinates care. Finally, in the discussion, the findings in this study are related to Andersheds and Ternestedt’s theory: 'participation in the light and participation in the dark'. Conclusion: The result shows that “participation in the light and participation in the dark” is strongly associated with the support and help family caregiver have access to. Integrating palliative care at an early stage, where the specialist nurse can act as contact person and coordinator of the care, increases the possibilities for relatives to “participate in the light” and increases the conditions for better health.

A continuous improvement project (CIP) is a structured improvement project using a team of people "typically representing different departments or units in the organization" working to improve a process or work area over a relatively short period of time, such as a few days or up to several months. A CIP may use different improvement methodologies and tools, and may thus be defined according to the improvement approach. For instance, an organization adopting Lean as an improvement approach is likely to have CIPs implementing Lean tools, such as 5S or value stream mapping. These projects may be referred to as Lean projects in general, although they may also represent accelerated improvement projects such as Kaizen events, Kaizen blitz, or rapid improvement projects. Alternatively, an organization utilizing Six Sigma as an improvement approach may have Six Sigma projects that use the Define-Measure-Analyze-Improve-Control (DMAIC) process and statistical tools. Some organizations adopt an integrated improvement approach, such as Lean Six Sigma, and therefore may have CIPs with an even broader set of tools from which to choose. Lastly, many organizations may have an improvement approach not characterized by any single set of improvement processes and tools, and thus, may be thought of generally as process improvement, or quality improvement, projects using a traditional methodology as plan-do-study/check-act (PDSA or PDCA). In this dissertation, all of these types of improvement projects are referred as CIPs. Since the 1980s, hospitals have been using CIPs to address some of the problems in hospitals, such as quality in healthcare delivery, internal process efficiency, communication and coordination, and the cost of services. Some hospitals have achieved significant improvements, such as reducing the turnaround time for clinical laboratory results by 60 percent and reducing instrumentation decontaminations and sterilization cycle time by 70 percent. However, as with many other companies, hospitals often experience difficulty achieving their desired level of improvements with CIPs. Therefore, the purpose of this dissertation is to identify the critical success factors (CSFs) related to CIP success. In order to achieve this goal, five objectives were achieved: creating a methodology to assess the maturity or evolution of a research field (manuscript #1), identifying a comprehensive list of CSFs for CIPs (manuscript #2), assessing the maturity of the published literature on CIPs in hospitals (manuscript #3), identifying the most important factors related to CIPs in hospitals (manuscript #4) , and conducting an empirical investigation to define the CSFs for CIPs in hospital settings (manuscript #5 and #6). This investigation was conducted in three phases: research framing, variable reduction, and model development and testing. During these phases, the researcher used the following methodologies and data collection tools: systematic literature review, maturity framework (developed as part of this dissertation), expert study, retrospective survey questionnaire, exploratory factor analysis, partial-least squares structural equation modeling, and regression modeling. A maturity framework with nine dimensions was created (manuscript #1) and applied in order to identify a list of 53 factors related to CIP in general, involving any organization (manuscript #2). Additionally, the maturity framework was used to assess the literature available on CIPs in hospitals, considering only the authorship characteristic dimension (manuscript #3). Considering the frequency of new authors per year, the relative new integration of research groups, and the limited set of predominant authors, the research field, or area, of CIPs in hospitals is one with opportunities for improving maturity. Using the systematic literature review from manuscript #3, the list of 53 factors, and the list of predominant authors, a review of the literature was conducted, along with an expert study to more fully characterize the importance of various factors (manuscript #4). A conclusion from this particular work was that it is not possible to reduce the list of 53 factors based on these results, thus, a field study using the complete comprehensive list of factors was determined to have stronger practical implications. A field study was conducted to identify factors most related to CIP perceived success (manuscript #5) and CIP goal achievement (manuscript #6). The final results and practical implications of this dissertation consist in the identification of the following CSFs for CIP success in hospitals: Goal Characteristics, Organizational Processes, Improvement Processes, and Team Operation. These CSFs include several specific factors that, to the researcher's knowledge, have not been previously studied in empirical investigations: goal development process, organizational policies and procedures, CIP progress reporting, and CIP technical documentation. Practitioners involved with CIPs, such as CIP leaders, facilitators, stakeholders/customers, and continuous improvement managers/leaders, can utilize these results to increase the likelihood of success by considering these factors in planning and conducting CIPs. / Ph. D.

Aging and deteriorating drinking water and wastewater pipelines have become a major problem in the United States, warranting significant federal attention and regulation. Many utilities have begun or improved programs to manage the renewal of their water and wastewater pipes and are proactively managing their pipeline assets rather than reactively fixing them. However, the extensive size of drinking water and wastewater systems and the severity of the deterioration problem are such that it is important to prioritize renewal, by assessing the condition of the pipelines and resolving the most severe situations first. There is a variety of condition assessment technologies and methodologies available and in current use. This research incorporates an extensive literature review on actual cases of use of these various condition assessment technologies and techniques. This research also compiles information gathered through interviews and data mining work with utilities across the United States. The combination of case studies collected through literature review and case studies collected directly from utility sources about actual application of drinking water and wastewater pipeline condition assessment practices used have made it possible to synthesize the current practices and trends regarding pipeline condition assessment in the United States. The synthesis also allows for the identification of key lessons learned that should be considered by utilities when implementing condition assessment of pipelines. Recommendations have also been made for research priorities for filling utility needs. / Master of Science

Bakgrund Afasi är en störning där personen har svårigheter att förstå och uttrycka sig verbalt. Personer som drabbas av afasi har försämrad kommunikationsförmåga och därför är det väsentligt att sjuksköterskan skapar en relation till patienten för att underlätta kommunikationen. Syfte Syftet var att beskriva sjuksköterskors erfarenheter av kommunikation med patienter som drabbats av afasi. Metod En systematisk litteraturöversikt, baserad på tio vetenskapliga artiklar, gjordes genom sökningar i databaserna Cinahl Complete och PubMed. Av de tio artiklarna var 5 kvalitativa, 2 kvantitativa och 3 av mixade metoder.  Resultat Ett huvudtema och ett tema framkom av resultaten: Olika strategier för kommunikation med patienter och Hinder för en god kommunikation. Huvudtemat Olika strategier för kommunikation med patienter byggs upp i sin tur av två underteman: Icke-verbal kommunikation och Vårdmiljöns betydelse. Utifrån sjuksköterskors erfarenheter framkom det att vissa kommunikationsstrategier, såsom korta meningar och bilder, påverkade kommunikationen med patienter som lider av afasi. Icke-verbal kommunikation och vårdmiljö spelade också en väsentlig roll för att underlätta kommunikationen med patienter. Faktorer som enligt sjuksköterskor utgjorde hinder för en god kommunikation med patienter var tidsbrist och bristande kompetens. Sjuksköterskors höga arbetsbelastning och tidspress gjorde att kommunikationen upplevdes även som tidskrävande. Bristande kompetens upplevde sjuksköterskor försvårade kommunikationen med patienter som lider av afasi.  Slutsats Kommunikationsstrategier upplevdes av sjuksköterskor främja en god kommunikation med patienter som drabbas av afasi, men tidsbrist utgjorde ett hinder för implementering av sådana strategier i praktiken. Bristande kompetens hos sjuksköterskor skapade tvivel vilket resulterade i att patienter som drabbas av afasi exkluderades från vården. En utveckling av kunskap hos sjuksköterskor är därför viktig för att ge en god omvårdnad, där patienten känner sig delaktig i sitt vårdande. / Background Aphasia is a disorder in which the person experiences difficulties in understanding and expressing themselves verbally. Individuals affected by aphasia have impaired communication abilities, so it is essential for nurses to establish a relationship to facilitate communication with patients. Aim The purpose of the study was to describe nurses' experiences in communication with patients affected by aphasia. Method A systematic literature review, based on ten scientific articles, was conducted through searches in the databases Cinahl Complete and PubMed. Out of these ten scientific articles, 5 were qualitative, 2 were quantitative, and 3 were mixed methods.  Results One main theme and one theme emerged from the results: Different strategies for communication with patients and Barriers to good communication. The main theme Different strategies for communication with patients is built upon two subthemes: Non-verbal communication and The importance of the care environment. Based on nurses' experiences, it emerged that certain communication strategies, such as short sentences and pictures, influenced communication with patients suffering from aphasia. Non-verbal communication and the care environment also played a significant role in facilitating communication with patients. Factors identified by nurses as obstacles to effective communication with patients were time constraints and inadequate competence. Nurses' high workload and time pressure made communication feel time-consuming. Nurses perceived insufficient competence as complicating communication with patients suffering from aphasia. Conclusions Nurses perceived communication strategies as facilitating good communication with patients affected by aphasia, but time constraints posed a barrier to implementing such strategies in practice. Inadequate competence among nurses created doubts, resulting in patients affected by aphasia being excluded from care. Therefore, the development of knowledge among nurses is important for providing quality care, where the patient feels involved in their own care.

Bakgrund: Antalet personer med multisjuklighet och polyfarmaci ökar i samhället. Läkemedelsrelaterade vårdskador och problem är vanligt förekommande i vården och polyfarmaci ökar risken. Läkemedelsgenomgångar är viktiga för att främja en säker läkemedelsanvändning och förebygga vårdskador. WHO beskriver läkemedelsgenomgångar som ett interprofessionellt teamarbete där ansvaret är delat mellan yrkesutövarna. Sjuksköterskor beskrivs kunna ha en egen och viktig roll i arbetet med läkemedelsgenomgångar. Syfte: Syftet med denna systematiska litteraturgranskning är att belysa sjuksköterskors erfarenheter av att utföra läkemedelsgenomgångar.  Metod: Studien är en systematisk litteraturgranskning och bygger på 16 kvalitativa vetenskapliga artiklar. Datainsamlingen genomfördes genom strukturerade databassökningar i Cinahl, Pubmed och Web of Science. Dataanalysen genomfördes enligt tematisk syntes av Thomas & Harden. Tillförlitligheten av sammanvägningen bedömdes enligt CERQual. Resultat: Två tredje nivå teman utgör resultatet med underliggande andra nivå teman. Utmaningar och brister vid läkemedelsgenomgångar: resursbrister vid genomförande av läkemedelsgenomgångar, brist på kompetens hos sjuksköterskor vid genomförande av läkemedelsgenomgångar, utmaningar i det professionella samarbetet vid läkemedelsgenomgångar, utmaningar vid läkemedelsgenomgångar i vårdens övergångar, organisatoriska utmaningar och brister vid läkemedelsgenomgångar, bristande delaktighet och kunskap hos patienter vid läkemedelsgenomgångar. Underlättande faktorer vid läkemedelsgenomgångar: fördelar med samarbete vid läkemedelsgenomgångar samt fördelaktiga utfall och gynnsamma faktorer vid läkemedelsgenomgångar.   Konklusion: Förekomsten av utmaningar och fördelaktiga utfall vid läkemedelsgenomgångar bland sjuksköterskors erfarenheter belyser behovet av patientens delaktighet, kompetensutvecklingen hos sjuksköterskor och att utveckla riktlinjer och den organisatoriska strukturen kring arbetet med läkemedelsgenomgångar. Genom att studera sjuksköterskors bidragande roll vid läkemedelsgenomgångar kan sjuksköterskans roll i arbetet formaliseras. / Background: The number of people living with multimorbidity and polypharmacy increases in society. Drug-related health care misses and problems are common and the risk increases with polypharmacy. Medication reviews are important to facilitate safe drug use and to prevent medical errors. WHO describes medication reviews as a multiprofessional teamwork where response is shared between the professionals. Nurses are described to be able to have their own important role within the work of medication reviews.    Aim: The aim of this systematic literature review is to illustrate nurses experiences of performing medication reviews. Method: The study is a systematic literature review and is constructed of 16 qualitative scientific articles. Data collection was made through structured database searches in Cinahl, Pubmed and Web of Science. For the data analysis a thematic synthesis of Thomas and Harden was performed. To evaluate the confidence in the evidence CERQual was performed. Result: Two third level themes constitute the result with underlying second level themes. Barriers and deficits in medication reviews: resource shortages while performing medication reviews, lack of competence among nurses performing medication reviews, barriers within the interprofessional teamwork while performing medication reviews, barriers in medication reviews at care transitions, organizational barriers and deficits in medication reviews and lack of participation and knowledge in patintens while performing medication reviews. Facilitators in medication reviews: apportioning with teamwork in medication reviews and facilitating outcomes and factors of medication reviews.   Conclusion: The presence of challenges and beneficial outcomes in medication reviews among nurses' experiences highlights the need for patient involvement, the development of nurses' skills, and the development of guidelines and the organizational structure around the work of medication reviews. By studying the contributing role of nurses in medication reviews, the role of the nurse can be clarified and formalized.

Bakgrund: Astma är ett betydande globalt folkhälsoproblem med allvarliga konsekvenser och kan i svåra fall leda till hög sjukdomsbörda och till och med dödsfall. Astmaattacker kan utlösas av faktorer såsom infektioner, fysisk ansträngning och allergener som pollen. Astma behandlas med luftrörsvidgande läkemedel. Sjuksköterskan har en betydande roll i att förbättra välbefinnande för personer som lever med astma genom att vara lyhörd och empatisk samt erbjuda stöd under sjukdomsförloppet. Syfte: Syftet var att beskriva vuxna personers erfarenheter av att leva med astma   Metod: En litteraturöversikt har genomförts enligt Fribergs metodbeskrivning med hjälp av åtta vetenskapliga originalartiklar. Dessa hämtades från databaserna Pubmed och CINAHL med ämnessökord “Asthma/psychology”, “asthma”, “severe asthma” och fritextsökord “experience”, “Living with”, “perception” och “patients’ life”. Resultat: Resultatet visar att vuxna med astma upplever betydande påverkan på sina liv. De kämpar med att utföra vardagliga sysslor och med att delta i fysisk aktivitet på grund av andningsbesvär. Deltagarna rapporterar även känslor av oro, stress, depression och ångest relaterad till sin sjukdom och dess framtid. Det framkommer att de saknar effektiva strategier för att hantera sin astma, förutom att planera i förväg för medicin och att övervaka sina symptom. Stöd från nära och vården betonas som avgörande för att minska stress och känslan av ensamhet kopplad till sjukdomen. Slutsats: Astma innebär betydande utmaningar för dem som lever med sjukdomen. Dessa utmaningar omfattar både fysiska och psykologiska aspekter, och personer kämpar för att hitta effektiva sätt att hantera sjukdomen. Det är av stor vikt att vårdpersonal tar hänsyn till patienternas behov genom att ge dem och deras familjer den information som behövs för att hantera sjukdomen på bästa sätt. Dessutom är det avgörande att erbjuda dessa individer personcentrerad vård för att förbättra deras livskvalitet och välbefinnande. / Background: Asthma is a global public health issue with serious consequences, and in severe cases, it can lead to high disease burden and even death. Asthma attacks can be triggered by factors such as infections, physical activity, and allergens such as pollen. Asthma is treated with bronchodilator medications. Nurses have to play a significant role in improving the quality of life for individuals living with asthma by being attentive and empathetic, and providing support throughout the course of the illness.  Aim: The aim was to describe the experiences of adult individuals living with asthma. Method: A literature review has been conducted following Friberg's method description, utilizing eight scientific original articles. These articles were retrieved from the PubMed and CINAHL databases using subject headings "Asthma/psychology", "asthma", "severe asthma", and free-text search terms "experience", "Living with", "perception", and "patients' life". Results: The results indicate that adults with asthma experience a significant impact on their lives. They struggle to perform daily tasks and with participating in physical activities due to breathing difficulties. Participants also report feelings of worry, stress, depression, and anxiety related to their condition and its future implications. It is evident that they lack effective strategies for managing their asthma, apart from planning ahead for medication and monitoring their symptoms. Support from loved ones and healthcare professionals is emphasized as crucial in reducing stress and the sense of loneliness associated with the illness. Conclusions: Asthma poses significant challenges for individuals living with this condition. These challenges enclose both physical and psychological aspects, with individuals striving to find effective ways to manage the disease. It is crucial for healthcare professionals to consider the needs of these patients by providing necessary information to both them and their families, enabling them to manage the condition effectively. Furthermore, it is essential to approach these individuals with person-centered care to enhance their standard of living and well-being.

Bakgrund: Transpersoner är en utsatt patientgrupp inom sjukvården, vilket även inkluderar röntgenavdelningar. Ofta finns det brister i bemötandet av patientgruppen då de blir utsatta för diskrimineringar och kränkningar vilket resulterar i att färre transpersoner väljer att söka fortsatt vård. En ökad förståelse för patientgruppens problem behövs för att främja god vård.   Syfte: Syftet med studien var att belysa transpersoners erfarenhet av bemötande inom vården.   Metod: En litteraturstudie bestående av resultaten från åtta kvalitativa studier genomfördes. Artiklarna söktes fram via PubMed och CINAHL. Artiklarna kvalitetsgranskades varefter deras resultat analyserades och sammanställdes.   Resultat: Tre huvudteman och sju underteman identifierades. De tre huvudtemana var En känsla av utsatthet, Träffa på okunskap samt Vilja bli respekterad. Resultatet visade på flertalet negativa känslor och upplevelser av bemötande från sjukvårdspersonal, men att detta kunde minskas när sjukvårdspersonalen visade på respekt, ärlighet och öppenhet.   Konklusion: Sjukvårdspersonal har ofta bristande kompetens om transpersoners vårdbehov. Röntgensjuksköterskan har en stor möjlighet att förbättra transpersoners upplevelser under röntgenundersökningar genom att visa respekt och öppenhet. Genom att öka sin kompetens inom bemötande av transpersoner samt få en bättre förståelse för deras specifika vårdbehov kan röntgensjuksköterskan skapa en bättre vård för patientgruppen och undvika att de undviker vård i framtiden. / Background: Transgender people are a vulnerable patient group within healthcare, which includes radiology departments. Transgender people are met by discriminating behavior from healthcare professionals which results in a reduced chance of seeking future care. An increased understanding of this patient group’s struggles is needed to facilitate good care.   Aim: The aim of this study was to describe transgender people’s experiences of interacting with healthcare staff and systems.   Methods: A literature review was conducted based on eight qualitative studies. Database searches were performed in PubMed and CINAHL. The studies were quality checked after which their results were analyzed and compiled.   Results: Three main themes and seven subthemes were identified; A Feeling of Vulnerability, Being Met with a Lack of Knowledge, and Wanting to Be Respected. The result described different aspects of interactions with healthcare professionals that were deemed as negative and caused gender dysphoria, although this could be avoided when the healthcare professional showed respect, honesty and openness.   Conclusion: Healthcare professionals often have a limited competency regarding the healthcare needs of transgender people. The radiographer can improve the healthcare experience of transgender people by showing respect and openness. The radiographer can improve transgender people’s healthcare experiences by increasing their competency relating to interacting with transgender patients and attaining a better understanding of their specific healthcare needs, leading to less of them avoiding healthcare in the future.

Bakgrund: ALS är en obotlig progressiv sjukdom med komplex symtombild, som leder till döden inom tre till fem år. Närstående har en central roll i den utmanande vården av en person med ALS, därför behöver sjuksköterskor få en fördjupad kunskap kring närståendes upplevelser av att vårda en person med ALS, för att uppnå en god palliativ vård. Syfte: Syftet var att belysa närståendes upplevelser av att vårda en person med  ALS. Metod: Litteraturöversikt med tematisk analys, baserad på resultatet från 13 kvalitativa studier och den kvalitativa delen av resultatet i tre mixade studier, totalt 16 studier. Resultat: Närståendes upplevelser beskrivs i fem teman. Förändrade relationer och roller belyser omfördelning av roller, känslor av identitetsförlust och otillräcklighet. Att behöva ta ansvar och fatta beslut speglar upplevelser av att vara i beredskap dygnet runt och att ställas inför svåra beslut. Den alltmer utmanade kommunikationen handlar om kommunikationssvårigheter och att vara tvungen att utveckla nya former för kommunikation. Strategier för att hantera det förändrade livet innefattar närståendes egna strategier för att hantera vården av en person med ALS. Det sista temat Tilltagande hjälpbehov illustrerar behov av information, medicinsktekniska hjälpmedel, psykosocialt stöd och en kontaktperson som samordnare av vården.  I resultatdiskussionen relateras resultatet till Andersheds och Ternestedts teori: ”delaktighet i ljuset och delaktighet i mörkret”. Slutsats: Resultatet visar att ”delaktighet i ljuset och delaktighet i mörkret” är stark associerat med vilket stöd och hjälp närstående har tillgång till. Att tidigt integrera palliativ vård, där specialistsjuksköterskan kan fungerar som kontaktperson och samordnare av vården, ökar möjligheten för närståendes ”delaktighet i ljuset” och ökar förutsättningar för en bättre hälsa. / Background: ALS (Amyotrophic Lateral Sclerosis) is a progressive and incurable disease with complex symptom, which often leads to death within three to five years. In order to provide good palliative care, nurses need to gain an in-depth understanding of the experiences of the next of kin in caring for a person with ALS, as family caregivers play an important role in the challenging care of a person with ALS. Aim: The aim was to highlight family caregivers’ experiences of caring for a person with ALS. Method: A literature review was conducted using thematic analysis to analyze the results of 13 qualitative studies, along with the qualitative part of three mixed studies, totaling 16 studies. Results: There are five themes that describe the experiences of family caregiver. Changing relationships and roles highlights how roles are redistributed, creating feelings of identity loss and inadequacy. Having to take responsibility and make decisions reflects experiences of being on call around the clock and facing difficult decisions. The increasingly challenging communication is about communication difficulties and the need to develop new forms of communication. Strategies to cope with an altered life situation describes family caregiver ‘own strategies for managing the care of a person with ALS. The final theme, Increasing need for assistance, highlights the importance of having access to information, medical aids, psychosocial support, and a contact person who coordinates care. Finally, in the discussion, the findings in this study are related to Andersheds and Ternestedt’s theory: 'participation in the light and participation in the dark'. Conclusion: The result shows that “participation in the light and participation in the dark” is strongly associated with the support and help family caregiver have access to. Integrating palliative care at an early stage, where the specialist nurse can act as contact person and coordinator of the care, increases the possibilities for relatives to “participate in the light” and increases the conditions for better health.

Yes / This paper aims to focus on systematically analysing and synthesising the extant research published on supply chain integration (SCI) area, given the significance of SCI research area. More specifically, the authors aim to answer three questions: “Q1 – What are the factors (e.g. both driving and inhibiting) that influence SCI?”, “Q2 – What are the key developments (e.g. both in research and industry) in SCI area?” and “Q3 – What are the approaches employed/discussed to integrate supply chains?”. Over the past decade, SCI has gained increasing attention in the supply chain management (SCM) context, both from the practitioners’ perspective and as a research area. In realising the global transformations and competitive business environment, a number of organisations are collaborating with their supply chain (SC) partners, to conduct seamless SC operations. A systematic and structured literature review is carried out to observe and understand the past trends and extant patterns/themes in the SCI research area, evaluate contributions and summarise knowledge, thereby identifying limitations, implications and potential directions of further research. Thus, to trace the implementation of SCI practices, a profiling approach is used to analyse 293 articles (published in English-speaking peer-reviewed journals between 2000 and 2013) extracted from the Scopus database. The Systematic Review Approach proposed by Tranfield et al. (2003) was followed to analyse and synthesise the extant literature on SCI area. The analysis presented in this paper has identified relevant SCI research studies that have contributed to the development and accumulation of intellectual wealth to the SCI and SCM area. Each of the 293 papers was examined for achieving the aim and objectives of the research, the method of data collection, the data analysis method and quality measures. While some of the papers provided information on all of these categories, most of them failed to provide all the information, especially for Q2 and Q3 that resulted in 23 and 21 papers, respectively. This study would have benefited from the analysis of further journals; however, the analysis of 293 articles from leading journals in the field of operations and SCM was deemed sufficient in scope. Moreover, this research has implications for researchers, journal editors, practitioners, universities and research institutions. It is likely to form the basis and motivation for profiling other database resources and specific operations and SCM-type journals in this area. This systematic literature review highlights a taxonomy of contextual factors driving and inhibiting SCI for researchers and SC practitioners to refer to while researching or implementing SCI. It also exemplifies some areas for future research, along with the need for researchers to focus on developing more practical techniques for implementing SCI and improving organisational performance. The prime value and uniqueness of this paper lies in analysing and compiling the existing published material in relation to Q1, Q2 and Q3, including examining other variables (such as yearly publications, geographic location of each publication, type of publication, type of research methods used), which lacks in the recent published five SCI literature review-based articles (by Kim, 2013; Leuschner et al., 2013; Alfalla-Luque et al., 2013; Parente et al., 2008; Fabbe-Costes and Jahre, 2007). This has been achieved by extracting and synthesising existing publications using “Supply Chain Integration” keyword. This paper provides a critique of the conceptual and empirical works in SCI discipline and offers research agendas that can stimulate future researchers to carefully explore the topic.