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The overall purpose of this thesis is two-fold; to illuminate the meaning of living with ‘impurity’ in terms of malodorous exuding ulcers, and the meaning of caring for people with ‘impure’ bodies in institutions and in people’s homes. The thesis comprises four papers based on studies using qualitative methods. To illuminate nursing care as narrated by 27 retired care providers in northern Sweden, seven audio recorded group dialogues were performed (I). The transcribed group dialogues were analysed using a hermeneutic approach. The findings formulated as cleanliness, order and clear conscience point to purity. By cleaning patients and their surroundings repeatedly, by preserving order in various ways and by keeping a clear conscience, nurses committed to preserving purity. This study opened up for questions concerning the meaning of ‘impurity’ and‘purity’ in nursing today leading to papers II-IV. Learning about ‘purity’ is possible through studying ‘impurity’. Audio recorded narrative interviews were performed to illuminate the meaning of living with malodorous exuding ulcers (II) and the meaning of caring for people with malodorous exuding ulcers (III). A phenomenological-hermeneutic method was used to analyse the nine transcribed interviews with patients (II) and 10 transcribed interviews with nurses (III). The comprehensive understanding of living with malodorous exuding ulcers (II) was formulated as being trapped in a debilitating process that slowly strikes one down. There is a longing for wholeness and purity. When finding consolation, i.e., encountering genuineness and feeling loved, regarded and respected as fully human despite ulcers, patients feel purified. The comprehensive understanding of caring for people with malodorous exuding ulcers (III) was formulated as being exposed to, and overwhelmed by suffering that is invading. One runs the risk of experiencing desolation when one cannot make the ulcers and malodour disappear and fails to protect patients from additional suffering. To illuminate nurses’ reflections on obstacles and possibilities providing care as desired by people with malodorous ulcers (IV), six nurses from a previous study (III) were interviewed. An illustration with findings from paper II was shown and participants were asked to reflect on obstacles and possibilities providing the care desired by patients. The 12 audio recorded transcribed interviews were analysed using qualitative content analyses. The interpretations were presented as one theme ‘striving to do ‘good’ and be good’. The sub-themes related to the obstacles were ‘experiencing clinical competence constraints’, ‘experiencing organisational constraints’, ‘experiencing ineffective communication’, ‘fearing failure’ and ‘experiencing powerlessness’. The sub themes related to possibilities were ‘spreading knowledge on ulcer treatments’, ‘considering wholeness’ and ‘creating clear channels of communication’. The meaning of living with ‘impurity’ in terms of malodorous exuding ulcers, and the meaning of caring for people with ‘impure’ bodies in institutions and in patients’ homes is interpreted as striving for purity. Patients experience impurity when feeling dirty, losing hope, and not being respected and regarded as fully human. Nurses experience impurity when failing to shield patients’ vulnerability and their own defencelessness, and when facing obstacles preventing them from providing good care and being good nurses. Both patients and nurses may experience purity through consolation. For nurses, mediating consolation presupposes being consoled by being recognised for their challenging work, being respected and included in multiprofessional teams supported by the health care organisation and the leaders. Then patients can become consoled, and feel restored and fully human again despite their contaminated body.

<p>The aim of this study is to examine the knowledge and experience of the bad breath among high school students in Kristianstad. A further objective was to measure the amount of VSC (Volatile Sulfur Compounds) among those who perceive themselves to have a bad breath. A questionnaire with 21 closed questions was distributed to 120 high school students from Kristianstad municipality who were between the ages of 17-20. The results of this study revealed that most of the students had good knowledge of halitosis. The majority of all participants thought it was important to smell fresh in the mouth and also experienced most of their breath as very good or good. Only a few felt that they had bad breath. However, these persons did think their breath affect their everyday life. Furthermore, they have never felt embarrassed or caught in embarrassing situations due to their breath. The results from the clinical examination was carried out on 8 of the 120 students and was designed to measure the amount of sulphurous gases in the oral cavity which revealed that the average values that emerged in the examination below is the limited values for having a poor breath.</p> / <p>Syftet med denna studie var att undersöka kunskapen och upplevelsen av dålig andedräkt hos gymnasieelever i Kristianstad, ytterligare ett syfte var att mäta mängden VSC (reaktiva svavelföreningar)  hos dem som upplever sig ha dålig andedräkt. En enkät med 21 slutna frågor delades ut till 120 gymnasieelever som var mellan 17-20 år och studerade i Kristanstads kommun. Av resultatet i denna studie framkom att de flesta av gymnasieeleverna hade goda kunskaper om halitosis. Nästan alla 120 som besvarade enkäten tyckte att det var viktigt att lukta fräsch i munnen och dessutom upplevde de flesta sin andedräkt som mycket bra eller bra. Endast ett fåtal (14% ) kände att de ibland hade dålig andedräkt. Hos dessa  påverkades inte andedräkten deras vardagliga liv och de hade aldrig blivit generade eller hamnat i pinsamma situationer på grund av sin andedräkt. Resultatet från den kliniska undersökningen som gjordes på 8 av de 120 elever som besvarade enkäten där mängden av de svavelhaltiga gaserna i munhålan mättes visade att i genomsnitt ligger värden som framkom i undersökningen under gränsvärden för att man skall ha dålig andedräkt.</p>

The aim of this study is to examine the knowledge and experience of the bad breath among high school students in Kristianstad. A further objective was to measure the amount of VSC (Volatile Sulfur Compounds) among those who perceive themselves to have a bad breath. A questionnaire with 21 closed questions was distributed to 120 high school students from Kristianstad municipality who were between the ages of 17-20. The results of this study revealed that most of the students had good knowledge of halitosis. The majority of all participants thought it was important to smell fresh in the mouth and also experienced most of their breath as very good or good. Only a few felt that they had bad breath. However, these persons did think their breath affect their everyday life. Furthermore, they have never felt embarrassed or caught in embarrassing situations due to their breath. The results from the clinical examination was carried out on 8 of the 120 students and was designed to measure the amount of sulphurous gases in the oral cavity which revealed that the average values that emerged in the examination below is the limited values for having a poor breath. / Syftet med denna studie var att undersöka kunskapen och upplevelsen av dålig andedräkt hos gymnasieelever i Kristianstad, ytterligare ett syfte var att mäta mängden VSC (reaktiva svavelföreningar)  hos dem som upplever sig ha dålig andedräkt. En enkät med 21 slutna frågor delades ut till 120 gymnasieelever som var mellan 17-20 år och studerade i Kristanstads kommun. Av resultatet i denna studie framkom att de flesta av gymnasieeleverna hade goda kunskaper om halitosis. Nästan alla 120 som besvarade enkäten tyckte att det var viktigt att lukta fräsch i munnen och dessutom upplevde de flesta sin andedräkt som mycket bra eller bra. Endast ett fåtal (14% ) kände att de ibland hade dålig andedräkt. Hos dessa  påverkades inte andedräkten deras vardagliga liv och de hade aldrig blivit generade eller hamnat i pinsamma situationer på grund av sin andedräkt. Resultatet från den kliniska undersökningen som gjordes på 8 av de 120 elever som besvarade enkäten där mängden av de svavelhaltiga gaserna i munhålan mättes visade att i genomsnitt ligger värden som framkom i undersökningen under gränsvärden för att man skall ha dålig andedräkt.

Swedish power plants have in general an overcapacity which means that they must import waste from abroad. The imported fuel consists of several types of waste, but the majority originates from municipal and commercial waste. EFO is one of the leading fuel supplying and transport companies in Sweden. The company is owned by eight power plants located all around Sweden. The waste is purchased from other countries and then shipped to Sweden. During the unloading of the ship, when the cargo hatches opens, the malodourous gases will escape and be released in to the air. These malodours can travel quite far and are extremely unpleasant to people who live close by. The aim of this thesis was to suggest ways on how to prevent or reduce the emission of malodours during unloading of bales containing municipal waste. The aim of the project was to determine the causes of malodours, to identify the most common odorants in municipal waste, what properties they have, how they can be affected and how to prevent the formation of them. The problem was tackled by theoretical and practical studies. The theoretical study was a literature study and the practical study was observation at Mälarenergi combined heat and power plant. The results are presented as a number of suggestions for how to prevent or reduce the emission of malodours during unloading of bales containing municipal waste. These suggestions were divide in to the three categories Storage, Unloading and At Port. The suggestions varied from using better sorted waste to researching the possibility to use a portable tent covering the cargo ship during unloading. It was recommended that EFO should use both short- and long-term plans and also conduct further research on other ways to reduce emission of malodours.The suggestions were not tested so it cannot with certainty be determined if the suggestions will reduce or prevent emission of malodour. No laboratory tests were done on the waste. Therefore, the contents and concentrations could not be confirmed. However, it is almost certain that even if there were a slight difference it would not lead to a change of the current treatment process of the MSW. Obviously, there should have been multiple observations carried out at Mälarenergi`s power plant on various occasions and at different weather conditions. Several observations should also have been done on EFO´s other power plants to confirm that the core of the malodour emission problem is the same for all power plants. Basing suggestions on results taken from one instance might not give the correct answer to the problem. Common for malodours found in MSW is that they are formed as a product of degrading MSW. Reducing or stopping the degradation process, will prevent the formation of these compounds. This can be done either by lowering the temperature of the waste bales, altering the pH, decreasing the water content and increasing the level of Oxygen. / De svenska kraft- och värmeverken är så effektiva att det svenska bränslet inte räcker till utan man måste importera från andra länder. Bränslet består till stor del av hushållsavfall och kommersiellt avfall. EFO är ett energianskaffnings- och transportföretag som delägs av åtta svenska el- och värmeleverantörer. De förser sina ägare med bränsle till deras kraft- och värmeverk runt om i landet. Majoriteten av det inköpta bränslet kommer från utlandet och fraktas till Sverige med fartyg. Problemet för boende i närområdet är att avfallet avger dålig lukt när det lastas av från fartyg till hamn. Syftet med den här rapporten var att undersöka hur man kan förhindra eller minska utsläpp av dålig lukt vid avlastning från fartyg till hamn samt att ge förslag på metoder som kan minska luktproblematiken. Övriga mål var att fastställa vilka de mest förekommande luktämnena är, orsaken till att de bildas, vilka egenskaper de har och hur man kan förhindra att de bildas. Arbete består av en litteraturstudie tillsammans med observation gjord på Mälarenergis kraftvärmeverk. Resultaten presenterades i form av ett antal förslag på sätt att minska utsläpp av dålig lukt vid avlastning. Dessa förslag indelades i de tre områdena Lagring, Avlastning och Hamn. Förslagen var breda och sträckte sig från användning av bättre sorterat avfall till att utreda om det finns möjligheter till användning av ett portabelt tält kring fartyget under avlastning. Utöver de presenterade förslagen för minskning av luktutsläpp gavs också rekommendationen att EFO bör använda sig av både kortsiktiga och långsiktiga planer samt forska på ytterligare sätt för att minska utsläpp av dålig lukt. Förslagen har inte prövats och det kan därför inte fastställas om de reducerar och förhindrar utsläpp av dålig lukt. Det gjordes heller inte några laboratoriska analyser på avfallets innehåll därför kan det inte bestämmas om avfallet innehåller samma ämnen och koncentrationer. Sannolikt skiljer sig inte värdena så pass mycket att det skulle kräva andra typer av luktreducerande metoder. Fler observationer borde ha gjorts både på Mälarenergis anläggning och på de andra delägarnas anläggningar. Observationerna skulle då också utförts vid olika tidpunkter samt vid olika väderlek. Det är möjligt att resultatet skulle vara annorlunda om det funnits data från fler observationer. Gemensamt för ämnen som avger dålig lukt är att de uppkommer som en produkt av nedbrutet avfall. Genom att bromsa eller stoppa nedbrytningsprocessen kommer uppkomsten av dessa luktämnen förhindras. Detta kan man göra genom att förändra pH, sänka temperaturen, minska fukthalten och öka syrenivån.