Bakgrund: Etisk stress upplevs av sjuksköterskorna när deras handlingar är moralisk rätta men de blir hindrade av att utföra dessa på grund av reella eller upplevda hinder. När etiska problem uppstår har sjuksköterskorna ICN´s etiska kod att stödja sig på. Sjuksköterskor som var involverade i patientnära vård var mer troliga att uppleva etisk stress. Den etiska stressen kan leda till att sjuksköterskorna lämnar sin profession. Syftet: Syftet med studien var att beskriva sjuksköterskornas upplevelse av etisk stress i omvårdnadsarbetet. Metod: Studien är en kvalitativ litteraturöversikt med induktiv ansats. Studien baseras på 12 artiklar som studerat etisk stress.  Dataanalysen skedde i fem steg enligt Friberg’s modell för analys av litteraturöversikt. Resultat: Två huvudkategorier identifierades i litteraturöversikten. Dessa var: Att vara begränsad i att ge rätt vård samt Att ta den lätta vägen istället för den rätta vägen. Slutsats: Reflektionen som ett redskap är undervärderat och bör tillämpas för att lindra etisk stress och/eller öka patientsäkerheten.  Etisk stress kan komma att öka då sjuksköterskeprofessionen står inför en stor personalbrist. / Background: Moral distress is experienced by the nurses when they know the right thing to do but are constrained by real or experienced obstacles. When ethical problems arise the nurses can rely on find support in ICN's ethical code. Bedside nurses where more likely to experience moral distress. Moral distress can result in nurses leaving the profession altogether. Aim: The aim of the study was to describe nurses’ experiences of moral distress in nursing care. Method: The study is a qualitative study with an inductive approach. It was a literature review conducted on 12 studies on moral distress. Data analysis was done in five steps according to Friberg model (2012a) for analysis of literature reviews. Result: Two main themes where identified in this literature review. These where "to be limited in conducting good care" and "taking the easy way instead of the right way". Conclusion: Reflection as a tool is undervalued and ought to be used to relieve moral distress and/or improve patient safety. Ethical stress may increase because the nursing profession is facing a major shortage of staff.

Bakgrund: Kvarvarande katetrar är vanligt förekommande i vården och det finns en mängd olika anledningar till att patienter ordineras dessa. Oftast sker ordinationen i samband med problem eller sjukdomar i urinvägarna. Med kvarvarande katetrar följer även en del komplikationer. Somliga komplikationer uppstår på grund av den teknik som används vid katetersättningen. Syfte: Syftet med denna litteraturstudie är att belysa patientens upplevelse av att leva med en kvarvarande kateter. Metod: En litteraturöversikt har gjorts i denna studie. Tio stycken resultatartiklar söktes fram, nio var kvalitativa och en var kvantitativ och de har sedan analyserats och tolkats för att sedan tematiseras. Artiklarna har hämtats från databaserna CINAHL Complete, PubMed och Psyc Info. Resultat: Resultatet beskrivs i två teman som presenterar skillnaderna mellan negativa upplevelser och positiva upplevelser. Resultatet visar att katetern kunde upplevas som ett hinder i vardagen och ofta upplevde deltagarna smärta, som vid urinvägsinfektion, oro eller obehag vid läckage och blockage. Självbilden och sexualiteten kunde förändras då vissa deltagare inte längre upplevde sig själva som kvinnliga eller manliga. Några deltagare upplevde även en positiv förändring i livet då de menade att katetern bidragit till en ökad frihet och trygghetskänsla. Diskussion: Metodens styrkor och svagheter bearbetas i metoddiskussionen. I resultatdiskussionen diskuteras resultatet med vårdvetenskapligt material och valda delar av Katie Erikssons omvårdnadsteori som belyser lidandet. / Background: Indwelling catheters are common in health care and there are multiple causes why patients get them prescribed. The most common reasons for the prescription is of difficulties and or diseases in the urinary tracts. Indwelling catheters are also an cause of complications like infections, pain or other catheter problems. Aim: The aim of this study was to explore the patient's experience of living with an indwelling catheter. Method: A literature review was conducted. Ten scientific articles were analyzed, interpreted, nine were qualitative and one was quantitative and then categorized into two themes. The articles were found from the databases CINAHL Complete, PubMed and Psyc Info. Results: The result presents two themes which represents the differences between the negative and the positive experiences from the patients. The result described that urinary catheter became an obstacle in the everyday life and were often the reason to urinary tract infection, anxiety, discomfort under leakage or blockage. The patients self-image and sexuality could sometimes change since some of the patients did not experienced themselves as the person they used to be before they got the urinary catheter. Some patients experienced a positive change in their life because they felt that the catheters contributed them with a sense of security and freedom. Discussion: The method's strengths and weaknesses are processed in the discussion. The result discussed articles and selected parts of Katie Eriksson nursing theory that highlights the suffering.

Due to poverty and a lack of stimulation, many children living in Low- and Middle income countries suffer from developmental delay and do not develop to their full potential. Yet, remarkable recovery is often possible given that early interventions are available. The aim of this systematic literature review was to find out what could be done to decrease the gap between the current development and the developmental potential among children aged 0-8 years, living in Low –and Middle income countries. The research questions were the following: What intervention programs are provided by communities in Low- and Middle income counties with the intention of training parents´ to support their children reaching their developmental potential? What are the impacts of the interventions on children’s development, and what are the impacts of the interventions on parents´ knowledge about children`s development? Twelve studies were identified through a database search. After analyzing the data two different types of intervention programs emerged: parenting programs and stimulation programs. The gap between children´s current developmental levels and their developmental potential was not measured in the studies.  However, the intervention programs show to have positive effects on informing parents regarding child development, as well as making positive impacts on children’s cognitive development and social skills. The interventions mainly focus on children under the age of three, while interventions focusing on older children are few and need to be further researched. Simple matters, such as home-made toys and interactive communication with the children, can make a big impact on children’s development, which prepares children for future education.

Bakgrund Evidensbaserad vård (EBV) är ett välkänt begrepp som används för att tillförsäkra patienter en säker vård som vilar på bästa tillgängliga bevis, beprövad erfarenhet och patientens individuella preferenser. Många studier har tidigare undersökt hinder för sjuksköterskor att bedriva och/eller implementera EBV för att förklara gapet som kan uppstå mellan teori och praktik. Färre studier har undersökt vilka faktorer som främjar sjuksköterskors användande av EBV. Syfte Att genom en litteraturöversikt beskriva vilka faktorer som främjar sjuksköterskors möjligheter att bedriva en evidensbaserad vård. Metod Studien genomfördes som en litteraturöversikt. Databaserna CINAHL, PubMed och Web of Science genomsöktes och 15 artiklar valdes ut (8 kvalitativa, 4 kvantitativa och 3 mixedmethod). Resultat Fem kategorier identifierades som främjande faktorer för sjuksköterskor att bedriva och/eller implementera EBV; arbetsmiljö, stöd, kunskap, sjuksköterskans inställning och organisation. Stöd i form utav underlättare var den mest framträdande faktorn. Slutsats Sjuksköterskan har ett individuellt ansvar att bedriva EBV och kan genom sin egen inställning påverka att en sådan vård bedrivs. De flesta främjande faktorer som framkom var dock tydligare kopplade till ledningen och chefens del i att främja användandet av EBV. / Background Evidence-based practice (EBP) is a well-known term used to ensure that patients receive a safe care based on the best research evidence, clinical expertise and patient individual preferences. A variety of studies have examined the barriers for nurses to conduct and/or implement EBP to explain the gap that can occur between theory and practice. Fewer studies have examined the factors facilitating nurses’ use of EBP. Aim Was to describe the factors facilitating nurses’ use of evidence-based practice through a literature review. Methods The study was conducted as a literature review. The databases searched were CINAHL, PubMed and Web of Science and 15 articles were chosen for the result (8 qualitative, 4 quantitative and 3 mixed-method). Results Five categories were identified as facilitating factors for nurses to conduct and/or implement EBP; work environment, support, knowledge, nurses’ attitude and organization. Support from facilitators were the most emerging factor. Conclusion Nurses have individual responsibility to conduct EBP and can through their attitude influence that it’s being used, though a majority of the facilitating factors identified were more direct connected to the leadership and managerial part in facilitating the use of EBP.

Bakgrund: På en akutmottagning kommer patienter i olika tillstånd och behov. Det är sjuksköterskan som ofta gör de första bedömningarna och därför är det av stor vikt att bemötandet från sjuksköterskan är positivt för att skapa trygghet. Ökat patientflöde och långa väntetider är några faktorer som är påvisade att kunna påverka upplevelsen för patienterna av sin vistelse på akutmottagningen. Syfte: Syftet med litteraturöversikten var att beskriva faktorer som påverkar patienters upplevelse av omvårdnad under sin vistelse på akutmottagning. Metod: Studien genomfördes som en litteraturöversikt. Databaserna CINAHL och PubMed användes för att söka efter artiklar. Resultat: Sex underkategorier valdes ut: bemötande, delaktighet, information, väntetid, kommunikation och kontinuitet, sjuksköterskans kunskap och kompetens. Resultatet visade att många patienter ansåg att sjuksköterskan var skicklig i sina arbetsuppgifter och var nöjda med bemötandet från sjuksköterskan, men att långa väntetider och bristande information påverkade upplevelsen av omvårdnad. Det fanns en tydlig önskan över att få mer information om sin väntetid, behandling och undersökningar. Brister i detta, skapade en otrygghet och en känsla av vara bortglömd hos patienterna. Slutsats: Sjuksköterskor på en akutmottagning behöver besitta en stor kommunikationsförmåga. Detta för att kunna ge patienterna en så bra upplevelse som möjligt. Slutsatser av resultatet har påvisat att det krävs förbättring inom flera områden för att ge patienter en bättre upplevelse av omvårdnaden under sin vistelse på akutmottagningen. / Background: To an emergency department people arrives with various states and needs. It is the nurse who often do the initial assessments and therefore it is of great importance that the response from the nurse is positive, to provide a feeling of security for the patient. Increased patient flow and long waits are a few factors that are proven to influence patients´ experience of their stay at the emergency department. Purpose: The purpose of the literature review is to describe factors that influence patients’ experience of care at the emergency department. Methods: The study was conducted as a literature review. CINAHL and PubMed databases were used to search for articles. Results: The analysis led to six subcategories: the encounter, participation, information, waiting time, communication and continuity, the Registered Nurse knowledge and skills. The results showed that many patients felt that the nurse was skilled with the nursing assignments and were happy with the response from the nurse, but the long waiting time and lack of information affected the experience of the nursing care at the emergency department. There was a clear desire from the patients to receive more information about their wait time, treatment and examination. Shortcomings of this, created insecurity and a feeling of being forgotten for the patients. Conclusion: Nurses at an emergency department need to possess great communication skills. To be able to give patients the best experience as possible at the emergency department. Conclusions of the results have shown the need for improvement in several areas, to increase a better experience for the patients during their stay at the emergency department.

Supply Chain Risk Management (SCRM) is rapidly becoming a most sought after research area due to the influence of recent supply chain disruptions on global economy. The thesis begins with a systematic literature review of the developments within the broad domain of SCRM over the past decade. Thematic and descriptive analysis supported with modern knowledge management techniques brings forward seven distinctive research gaps for future research in SCRM. Overlapping research findings from an industry perspective, coupled with SCRM research gaps from the systematic literature review has helped to define the research problem for this study. The thesis focuses on a holistic and systematic approach to modelling risks within supply chain and logistics networks. The systems thinking approach followed conceptualises the phenomenon of risk propagation utilising several recent case studies, workshop findings and focus studies. Risk propagation is multidimensional and propagates beyond goods, finance and information resource. It cascades into technology, human resource and socio-ecological dimensions. Three risk propagation zones are identified that build the fundamentals for modelling risk behaviour in terms of cost and delay. The development of a structured framework for SCRM, a holistic supply chain risk model and a quantitative research design for risk assessment are the major contributions of this research. The developed risk assessment platform has the ability to capture the fracture points and cascading impact within a supply chain and logistics network. A reputed aerospace and defence organisation in UK was used to test the experimental modelling set up for its viability and for bridging the gap between theory and practice. The combined statistical and simulation modelling approach provides a new perspective to assessing the complex behavioural performance of risks during multiple interactions within network.

Bakgrund: Tidigare forskning redogör att patientens delaktighet har utvecklas genom årtionden, från ett paternalistiskt perspektiv till att patienten förväntas delta och fatta beslut. Patientens lagliga rätt till delaktighet styrks i Patientlagen och det är sjuksköterskans uppgift att skapa möjligheter för detta. En god vårdrelation krävs för att få kunskap och möjlighet till delaktighet. Syfte: Syftet var att belysa patienters upplever av delaktighet i hälso- och sjukvård. Metod: En systematisk litteraturstudie med beskrivande syntes för kvalitativa artiklar. Resultat: Patienters upplevelser av delaktighet i Hälso- och sjukvård redogörs i två teman: hinder för delaktighet och möjligheter för delaktighet. För att vara delaktig krävdes det att patienten får mera kunskap och information. Slutsatser: En god vårdrelation och informationsutbyte med sjuksköterska kan skapa goda förutsättningar för att göra patienten delaktig i sin vård och behandling. Patienten upplever dock att exempelvis vårdmiljön, vårdpersonalens attityder och sjukdomen inverkar på deras möjligheter för delaktighet. / Background: Previous research explains that the patient's participation has evolved through the decades, from a paternalistic approach to the patient expected to participate and make decisions. The patient's legal right to participation is evidenced in the Swedish Patient law (Patientlagen) and it is the nurses responsibility to create opportunities for this. A good care relationship is required to enable patients to get the knowledge and opportunity to participate. Aim: to describe patients' experience of participation in health care. Method: A descriptive systematic literaturestudy of synthesis of qualitative articles. Result: Patients experiences of participation in health care is described in two themes: the obstacles to participation and opportunities for participation. To participate, the patient needs to get more knowledge and information. Conclusion: A good relationship and exchange of information with the nurse can create favorable conditions to enable patient involvement in their care and treatment. The patients experience, however, that the care environment, care staff attitudes and the disease affects the patient's opportunities for participation.

Data quality is an important issue which has been addressed and recognised in research communities such as data warehousing, data mining and information systems. It has been agreed that poor data quality will impact the quality of results of analyses and that it will therefore impact on decisions made on the basis of these results. Empirical software engineering has neglected the issue of data quality to some extent. This fact poses the question of how researchers in empirical software engineering can trust their results without addressing the quality of the analysed data. One widely accepted definition for data quality describes it as `fitness for purpose', and the issue of poor data quality can be addressed by either introducing preventative measures or by applying means to cope with data quality issues. The research presented in this thesis addresses the latter with the special focus on noise handling. Three noise handling techniques, which utilise decision trees, are proposed for application to software engineering data sets. Each technique represents a noise handling approach: robust filtering, where training and test sets are the same; predictive filtering, where training and test sets are different; and filtering and polish, where noisy instances are corrected. The techniques were first evaluated in two different investigations by applying them to a large real world software engineering data set. In the first investigation the techniques' ability to improve predictive accuracy in differing noise levels was tested. All three techniques improved predictive accuracy in comparison to the do-nothing approach. The filtering and polish was the most successful technique in improving predictive accuracy. The second investigation utilising the large real world software engineering data set tested the techniques' ability to identify instances with implausible values. These instances were flagged for the purpose of evaluation before applying the three techniques. Robust filtering and predictive filtering decreased the number of instances with implausible values, but substantially decreased the size of the data set too. The filtering and polish technique actually increased the number of implausible values, but it did not reduce the size of the data set. Since the data set contained historical software project data, it was not possible to know the real extent of noise detected. This led to the production of simulated software engineering data sets, which were modelled on the real data set used in the previous evaluations to ensure domain specific characteristics. These simulated versions of the data set were then injected with noise, such that the real extent of the noise was known. After the noise injection the three noise handling techniques were applied to allow evaluation. This procedure of simulating software engineering data sets combined the incorporation of domain specific characteristics of the real world with the control over the simulated data. This is seen as a special strength of this evaluation approach. The results of the evaluation of the simulation showed that none of the techniques performed well. Robust filtering and filtering and polish performed very poorly, and based on the results of this evaluation they would not be recommended for the task of noise reduction. The predictive filtering technique was the best performing technique in this evaluation, but it did not perform significantly well either. An exhaustive systematic literature review has been carried out investigating to what extent the empirical software engineering community has considered data quality. The findings showed that the issue of data quality has been largely neglected by the empirical software engineering community. The work in this thesis highlights an important gap in empirical software engineering. It provided clarification and distinctions of the terms noise and outliers. Noise and outliers are overlapping, but they are fundamentally different. Since noise and outliers are often treated the same in noise handling techniques, a clarification of the two terms was necessary. To investigate the capabilities of noise handling techniques a single investigation was deemed as insufficient. The reasons for this are that the distinction between noise and outliers is not trivial, and that the investigated noise cleaning techniques are derived from traditional noise handling techniques where noise and outliers are combined. Therefore three investigations were undertaken to assess the effectiveness of the three presented noise handling techniques. Each investigation should be seen as a part of a multi-pronged approach. This thesis also highlights possible shortcomings of current automated noise handling techniques. The poor performance of the three techniques led to the conclusion that noise handling should be integrated into a data cleaning process where the input of domain knowledge and the replicability of the data cleaning process are ensured.

Bakgrund: Adjuvant cytostatikabehandling används vid bröstcancer efter att tumören tagits bort. Biverkningar kan uppstå då cytostatika påverkar alla kroppens celler. För att sjuksköterskan ska kunna ge en god omvårdnad krävs det att hon/han får ta del av patienters upplevelser vid adjuvant cytostatikabehandling. Syfte: Syftet var att beskriva kvinnors upplevelser av adjuvant cytostatikabehandling vid bröstcancer. Metod: En litteraturöversikt som baserades på 13 vetenskapliga artiklar med kvalitativ ansats utfördes. Resultat: Resultatet utgjordes av tre huvudkategorier: uppleva en förändrad kropp, uppleva ett förändrat sinne och upplevd påverkan på det sociala livet. Det framkom att kvinnorna upplevde både fysiska och psykiska biverkningar och dessa hade en stor påverkan på deras sociala liv. Slutsats: I slutsatsen betonas vikten av sjuksköterskans stöd i form av information och omvårdnad. / Background: Adjuvant chemotherapy is used to treat breast cancer after the removal of the tumour. Side effects may occur since chemotherapy affects all of the body cells. The nurse should be able to provide good care, to do so it requires that she/he takes part of patients’ experiences of adjuvant chemotherapy. Aim: The aim was to describe women’s experiences of adjuvant chemotherapy for breast cancer Method: A literature review based on 13 scientific articles with qualitative approach was executed. Results: The result consisted of three main categories: experiencing a changed body, experiencing a changed mind and perceived impact on social life. It was revealed that women experienced both physical and psychological side effects and they had a great impact on their social life. Conclusion: The conclusion shows the importance of the nurse’s support in form of information and care.

Bakgrund: Bröstcancer är den vanligast förekommande tumörsjukdomen hos kvinnor och årligen drabbas 8000 personer i Sverige. Risken för återfall är störst de fem första åren, denna risk för återfall kan väcka en rädsla. Syfte: Att beskriva bröstcancerdrabbade kvinnors upplevelse av rädsla för återfall. Metod: En allmän litteraturstudie. Den systematiska litteratursökningen resulterade i tio kvalitativa artiklar. Resultat: Rädsla för återfall var den mest förekommande känslan och den utlöstes främst vid förändringar i kontakten med sjukvården, uppkomsten av oförklarliga fysiska symtom och läkarbesök. Dock förekom det avsaknad av rädsla för återfall hos vissa. Det framkom även att användande av socialt stöd, distraktion och ett positivt synsätt var återkommande bemästringsstrategier för att hantera rädslan för återfall. Diskussion: Det är av stor vikt att sjuksköterskan informerar och motiverar kvinnan till utvecklande av egna bemästringsstrategier. Slutsats: Kunskapen kan och bör tillämpas av sjuksköterskestudenter och sjuksköterskor, för att minska frekvensen av rädsla för återfall hos personer med cancer. Området bör uppmärksammas för vidare forskning. / Background: Breast cancer is the most common cancer disease among women and 8000 people is annually affected in Sweden. The risk of recurrence is the highest within the first five years. The risk can trigger a sense of fear. Aim: To describe how women with breast cancer experience fear of recurrence. Method: A literature review. The systematic literature search resulted in ten qualitative articles. Results: Fear of recurrence was the most frequent emotion and was primarily triggered by changes in contact with health care, the emergence of unexplainable physical symptoms and doctor appointments. Though, absence of fear of recurrence occurred among some women. Usage of social support, distraction and positive approach emerged to be the most common coping strategies to deal with fear of recurrence. Discussion: It’s significant that the nurse informs and motivates women to the development of their own coping strategies. Conclusion: The knowledge can and ought to be practiced by nursing students and nurses, to reduce the frequency of fear of recurrence among people with cancer. This field ought to be noticed for further research.