The purpose of this study was to investigate registered nurses experiences about the current model for triage at the emergency department at Uppsala University Hospital. The study is descriptive with qualitative approach. The data collection was made in the form of semi structured interviews. The interviews took place at the emergency department. The sample consisted of eight registered nurses with varying work experience of emergency care. The interviews were transcribed and analyzed. The content analysis resulted in 14 categories and four themes. The main result contains both positive and negative experiences concerning registered nurses situation when working with team triage. Team triage has improved the work in many aspects: it runs more smoothly and inspires to a good working climate. At the same time the informants experienced the lack of guidelines on how team triage should be conducted. Working in team has improved the cooperation with the physicians. An important factor to this is good communication. However, numerous of the informants felt that they were of no use when working in team. It was also a lack of interest from the physicians of working in team with registered nurses. Further research is required on this topic to develop and improve the way to work with team triage.

To sort, is the meaning of the word “triage”. Triage is used at emergency departments to facilitate prioritization of patients according to the urgency of the chief complaint. The aim of this study was to investigate how the nurses experience the triage model at the emergency department at Uppsala university hospital. Twelve nurses were interviewed. The mean age was 40 years and the mean work experience was three years and four months. An interview guide was used, consisting of questions about triage, collaboration and work situation. The nurses perceived that triage supports assessment and prioritization of patients. Different triage models were used depending on the nurses’ level of triage-education, which was perceived as problematic. The nurses perceived safety when triage was performed together with the physician. The level of collaboration, between the nurses and the physicians, was experienced to be person-dependent. The importance of good communication between nurses and physicians were highlighted. Triage supports the assessment and prioritization of patients. A standardized triage model would increase the quality of care. The collaboration between nurses and physicians could be improved if they receive the same information and education about triage. Improved communication will facilitate the collaboration. Physicians should participate in the triage process.

Barnmisshandel kan förekomma i alla samhällsklasser, trots att det enligt lag är förbjudet att slå sitt barn. Barnmisshandel brukar delas in i fysisk-, psykisk- och sexuell misshandel. För att kunna identifiera barnmisshandel måste skolsköterskan ha kunskap inom området, vilket saknas idag. Syftet med studien är att beskriva skolsköterskors kunskap och roll i att identifiera barnmisshandel. Studien utfördes som en litteraturgranskning och belyser flera tecken som skolsköterskan bör observera vid misstänkt barnmisshandel. Att det råder kunskapsbrist inom området, både då det gäller att upptäcka, identifiera och rapportera barnmisshandel framkom tydligt i studien. Skolsköterskan är i en bra position för att upptäcka barnmisshandel och hjälpa utsatta barn. Genom hälsosamtalet kan skolsköterskan uppmärksamma barn som kan vara utsatta för våld; begreppet KASAM är angeläget att ha med sig i det hälsofrämjande arbetet. I samtalet med barnet är det viktigt med en bra samtalsmetod. För att i ett tidigt skede uppmärksamma barn som utsätts för misshandel behövs tydliga riktlinjer och rutiner, kontinuerlig och fortlöpande utbildning inom området för att överbrygga den kunskapsbrist som finns. / Child abuse can occur in all social classes, even if it´s forbidden to hit the child according to the law. Child abuse usually divides in physical-, psychic- and sexual abuse. To identify maltreatment the school nurse needs knowledge about this field, which is missing today. The aim of the study is to describe school nurses knowledge and function to identify child abuse. The study is a literature review and it illuminates several signs that a school nurse should observe at suspected child abuse. It counsels lack of knowledge about maltreatment, both to describe, identify and report child abuse. The school nurse is in a good position to recognize child abuse and to help exposed children. Through the health conversation the school nurse can observe children that can be exposed to violence; the concept SOC is important in the health promotion. In the conversation with the child it´s important to have good method of conversation. To early observe children that have been exposed for maltreatment it´s a need of clear guidelines and routines, continuous education inside the subject child abuse in able to over bridge the lack of knowledge.

Depression hos äldre har blivit ett stort hälsoproblem. Idag är depression den vanligaste psykiatriska sjukdomen bland äldre. Om en depression inte identifieras kan den leda till allvarliga konsekvenser. En av sjuksköterskans uppgifter kan vara att identifiera depression hos äldre personer. Syftet med denna litteratur studien var att ta reda på sjuksköterskans svårigheter och möjligheter i att identifiera depression hos äldre. Den valda metoden var en kvalitativ litteraturstudie och gjordes enligt Friberg (2001). Den kunskap som framkom om sjuksköterskan kategoriserades i svårigheter att identifiera depression och möjligheter i att upptäcka depressionen. Resultatet av studien visar att sjusköterskor har svårigheter i att identifiera depression hos äldre, men det finns möjligheter att förbättra en identifiering. När den äldre deprimerade maskerar sina depressiva symtom i somatiska sjukdomar, kan sjuksköterskan få svårigheter att identifiera depressionen. Det kan också finnas attityder hos sjuksköterskor, att människan blir deprimerad på äldre dagar. Detta kan leda till att depressionen inte identifieras. Genom att använda sig av kommunikation, GeriatricDepression Scale (GDS), kunskap från närstående och utbildning ökar sjuksköterskans möjligheter att identifiera en depression och därmed minska lidandet för den äldre. Slutsatsen som dras är att det behövs mer utbildning för sjuksköterskor i att kunna identifiera depression hos den äldre personen. / Depression in elderly people has become a big health problem. Today, depression is the most common psychiatric illness amongst elderly. If depression is not identified, it can lead to serious consequences. One of the nurse’s duties could be identify depression in elderly people. The purpose of this literary study was to find the nurse’s difficulties and possibilities in identifying depression in elderly. The chosen method was a qualitative literary study and was carried out according to Friberg (2001). That knowledge that emerged about the nurses was categorised in difficulties in identifying depression and possibilities of discovering this. The result of the study shows that nurses have difficulties in identifying depression in elderly, but there are possibilities to improve an identification. When the depressed elderly disguises the depressive symptoms in somatic illnesses, the nurse may have difficulties in identifying the depression. There may also be the attitude of the nurses, that depression is part of the aging process. This may lead to that depression is not identified. By using communication, the Geriatric Depression Scale (GDS), information from people close to the patient and education, the nurse’s possibilities in identifying a depression are increased and can thereby reduce the suffering of the elderly. The conclusion is that nurses need more education to be able to identify depression in eldery.

The study aimed to evaluate the information and training the stoma therapist at Uppsala University Hospital has given to patients who have recently undergone stoma surgery. The study was a descriptive cross-sectional study using qualitative and quantitative design. A total of 22 patients who completely or partially took care of their stomas and recently had undergone stoma surgery participated by answering a questionnaire. At discharge most of them experienced they were relatively well-informed but they wanted more information. Before the revisit they weren’t especially safe or comfortable. The participants felt they were better informed and more safe and comfortable three weeks to six months after surgery. Whether the patients had undergone a planned or acute surgery did not influence how wellinformed, safe and comfortable in stoma management they were. No differences were found regarding how safe and comfortable in stoma management the patients were related to how long time ago they underwent the operation. Patients wanted additional information about diet, intestinal function and stoma care and more practice in changing stoma materials. Recently operated stoma patients need information and training until they feel sufficiently well-informed, safe and comfortable in order to better manage their stoma at home after discharge. / Studien syftade till att utvärdera den information och utbildning som stomiterapeuten vid Akademiska sjukhuset har gett till patienter som nyligen genomgått en stomioperation. Studien var en deskriptiv tvärsnittsstudie med såväl kvalitativ som kvantitativ design. Sammanlagt 22 patienter som helt eller delvis skötte sin stomi och nyligen genomgått en stomioperation deltog i studien genom att svara på ett frågeformulär. Vid utskrivning upplevde de flesta av deltagarna att de var relativt välinformerade men de önskade mer information. Innan återbesöket var de varken särskilt säkra eller trygga med stomiskötseln. Patienterna upplevde att de var mer välinformerade, trygga och säkra tre veckor till sex månader efter operation. Huruvida de hade genomgått en planerad eller akut operation påverkade inte hur välinformerade, trygga och säkra på stomiskötseln de var. Det kunde inte heller påvisas någon skillnad mellan hur trygga och säkra på stomiskötseln patienterna var relaterat till hur länge sedan de genomgick operationen. Patienterna önskade ytterligare träning på att byta stomimaterial samt mer information kring kost, tarmens funktion samt stomiskötsel innan utskrivning. Nyopererade stomipatienter skulle behöva information och utbildning tills de känner sig tillräckligt välinformerade, trygga och säkra för att bättre kunna sköta sin stomi i hemmet efter utskrivning.

Syftet med denna beskrivande litteraturstudie var att belysa sjuksköterskors attityder gentemot patienter med psykisk ohälsa. En litteratursökning genomfördes och 12 vetenskapliga artiklar valdes ut till det slutliga resultatet. Resultatet visade att sjuksköterskorna hade en rädd attityd, en stressad attityd, en osäker attityd, en säker attityd samt en diskriminerande attityd gentemot patienter med psykisk ohälsa. Samhällets stigmatiserade syn på psykisk ohälsa påverkade sjuksköterskorna negativt i deras yrkesroll då de kunde utveckla en rädd, osäker och diskriminerande attityd.  Kunskap och erfarenhet om psykisk ohälsa var något som resultatet visade förbättrade sjuksköterskornas bemötande och gav dem en säker attityd. Sjuksköterskornas arbetsmiljö som i dagens samhälle kan innebära stress och nedskärningar leder till en negativ och stressad attityd samt en sämre patientrelation. Information och utbildning om psykisk ohälsa är något som författarna till föreliggande studie anser är av stor vikt för att minska den stigmatiserande och diskriminerande attityden hos sjuksköterskor. Slutsatsen av denna studie visar på att sjuksköterskornas attityder gentemot patienter med psykisk ohälsa är av både positiv och negativ karaktär som grundas i dagens samhälles stigmatiserade syn, kunskapsbrist samt sjuksköterskornas livserfarenheter och värdegrunder. / The aim of this descriptive literature review was to illuminate nurses´ attitudes towards patients with mental illnesses. A literature search was performed and 12 scientific articles were chosen which form the basis of this report. The result of this study shows that nurses had five main attitudes, a frighten attitude, a stressed attitude, an unsecure attitude, a confident attitude and a discriminating attitude towards patients with mental illnesses. Nurses´ attitudes towards patients with mental illness are affected by society's stigmatized view of people with mental illnesses. Nurses´ attitudes towards patients with mental illnesses include fear, insecurity and discrimination. Knowledge and experience of patients with mental illnesses resulted in more confident attitudes towards these patients and improved their interaction with them. Nurses work in a more stressful environment than previously, partly due to economic strains on health care leading to staff reduction which affects nurses´ relationships with their patients negatively. Information and education about mental illnesses is something which the authors of this study believe is of great importance in order to reduce the stigmatization and discriminating attitude held by nurses towards patients with mental illnesses. The conclusion of this study shows that nurses´ attitudes towards patients with mental illnesses are of both negative and positive character which origins in society’s stigmatized view, lack of knowledge and the nurses experiences in life and their values.

Självskadebeteende har uppmärksammats allt mer i samhällsdebatten under senare tid. Sjuksköterskan möter ofta patienter med ett självskadebeteende. Syftet med studien var att beskriva sjuksköterskans attityder till patienter med självskadebeteende. Metoden var en litteraturstudie och datamaterialet bestod av nio vetenskapliga artiklar, publicerade mellan åren 2000-2007. Det analyserade materialet bildade tre teman som visade sjuskköterskors attityder till patienter med ett självskadebeteende: Ej rätt till vård, Erbjuder vård utan hopp om förändrat beteende och Rätt till vård. Det framkom att känslor som vrede, rädsla, misslyckande och hopplöshet var kopplade till attityderna till patienter med självskadebeteende. Faktorer som kan påverka sjuksköterskans attityd till självskadebeteende kan inte enkelt beskrivas som negativa eller positiva enligt denna litteraturstudie. Fortsatta studier kan inriktas på att beskriva om attityderna förbättras eller inte och vilka faktorer som påverkar attityderna.

The aim of this study was to describe how nurses cope with their daily stress at work. A literature review was made to answer the research question, data was gathered from two databases; Academic Search Elite and Medline (via Pubmed). The result which was based on 20 scientific articles showed that nurses used problem-focused and emotional-focused coping strategies to deal with the stress at work. Most of the nurses used emotional-focused coping strategies by practise some kind of physical activities, avoid and take distance from the problem. Using these strategies was negative correlated with burnout and psychological health. In four of the studies problem-focused coping strategies was the most dominant, by trying to find a concrete problem solving strategy and to find direct alternative to deal with the stress. The use of these strategies had a negative relation to psychological and physical health, but a positive correlation to feel satisfaction at work and the nurses that used this strategies experienced lower stress than those who used emotional- focused strategies. / Syftet med denna studie var att beskriva hur sjuksköterskor hanterar sin dagliga stress i arbetet. För att besvara frågeställningen gjordes en litteraturstudie, data samlades in från databaserna Academic Search Elite och Medline (via Pubmed). Resultatet som baserades på 20 vetenskapliga artiklar visade att sjuksköterskor hanterade sin dagliga stress på arbetet genom problemfokuserade och känslomässiga copingstrategier. De flesta använde sig av känslomässiga copingstrategier genom att bland annat utöva någon form av fysisk aktivitet, undvika och distansiera sig från problemen. Användningen av dessa strategier hade ett negativt samband med utbrändhet samt psykisk ohälsa. Fyra av studierna tog upp problemfokuserade copingstrategier som de mest använda strategierna, genom att bland annat försöka finna en konkret problemlösning och hitta direkta alternativ att hantera stressen. Användningen av dessa strategier hade ett negativt samband till psykisk och fysisk hälsa, men positivt samband till att känna tillfredsställelse på arbetet samt att sjuksköterskor som använde sig av dessa strategier upplevde lägre stress på arbetet än de som använde sig av känslomässiga copingstrategier.

This study focuses on the nurse education at Uppsala University and more precisely on the final semester of practical training on site, where nurse students are instructed and supervised by their professional equivalents. This training period is supposed to enable the symbiosis of theoretical and practical knowledge for the student, turning her into a fully educated and independent professional. However, the period is however not unproblematic. The aim of the study is therefore to explore this practical training period with particular emphasis on the perceptions held by nurse students and nurse instructors regarding the prerequisites, process and outcome of this training. Based on a theoretical framework that draws on Wenger’s social theory of learning and its concept of communities of practice a case study is conducted focusing on the municipality of Uppsala. Interviews with three nurse students and three nurse instructors were carried out. The empirical findings suggest that the training period is an essential part of the nurse education where nurse students’ theoretical knowledge becomes instrumentalised. However, the period has many shortcomings such as a lack of continuity and an unnessary complexity that limit the practical knowledge that can be gained by the nurse students.

Innan en patient som bedöms vara i behov av insatser från kommunens socialtjänst eller annan öppenvård med mera skrivs ut från slutenvården måste en vårdplanering utföras. Vårdplaneringen utförs av patientansvarig sjuksköterska tillsammans med ett antal representanter från öppenvården. Syftet med studien är att belysa hur sjuksköterskor inom landstinget upplever samordnad vårdplanering. Metoden som användes var en kvalitativ enkätundersökning. Resultatet baseras på tio enkäter ifyllda av sjuksköterskor på lungmedicin på KSS i Skövde. Dessa enkätsvar gick sedan igenom en kvalitativ innehållsanalys för att urskilja upplevelser hos sjuksköterskorna. I resultatet framkom att sjuksköterskorna upplevde stress, frustration, dåligt samvete samt bristande samarbete men att sjuksköterskorna accepterade situationen och jobbade vidare. / A coordinated care plan must be carried out before a patient in closed care, that need help from the municipality social services or other open care institutions, can be discharged. This coordinated care planning is accomplished by a team consisting of the nurse responsible for the patient together with a number of representatives from the municipal care. The aim with the study is to elucidate how nurses within the county council experience the coordinated care planning. The method used in this study was a qualitative questionnaire survey and the answers were assessed by using a qualitative content analysis. The results are based on ten questionnaires answered by nurses working at the lung medicine ward in Kärnsjukhuset, Skövde. This study revealed that the nurses experienced stress, frustration, bad conscience and inadequate cooperation in the coordinated care planning; however, they accepted the situation and kept on working.