Palliativ vård innebär ett förhållningssätt där patientens livskvalitet står i centrum. Vården kännetecknas av en holistisk människosyn där patientens fysiska, psykiska, sociala samt existentiella behov ska tillgodoses. Från sjuksköterskans perspektiv kan palliativ vård bedrivas inom såväl primärvård som slutenvård och omfattningen av det palliativa vårdandet varierar beroende på inom vilket område sjuksköterskan är verksam. Oavsett kontext har sjuksköterskan en relations­skapande funktion och relationen har stor betydelse för patientens välbefinnande. Professionell hållning inom palliativ vård innebär att sjuksköterskan medvetet tillämpar ett empatiskt förhållningssätt. Syftet var att beskriva sjuksköterskans upplevelse av att förhålla sig professionellt i relationen till patienten inom palliativ vård. Studien genomfördes i form av en vetenskaplig litteraturöversikt med systematisk insamling och granskning av data. Totalt inkluderades elva kvalitativa, vetenskapliga artiklar. Databearbetning resulterade i tre kategorier: ”Den unika relationen”, ”Sjuksköterskans utmaning” samt ”Professionell distansering”. Sjuksköterskor upplevde att relationen inom palliativ vård präglades av närhet och känslomässigt engagemang. Den nära relationen ansågs positiv samtidigt som den innebar en risk för emotionell överbelastning. Nödvändigt var att upprätta en professionell distans för att kunna särskilja yrkesliv och privatliv. Sjuksköterskor identifierade i det en utmaning att balansera mellan närhet och distans och att kunna vara personlig utan att bli privat. / Palliative care is an approach which has the main emphasis on the patient’s quality of life. It is characterized by a holistic view towards the patient’s physical, psychological, social and existential need. The nurse can work with palliative care in many different contexts, and to various degrees. Nonetheless, the nurse who conducts palliative care will always have a relation building function, and the relation between the nurse and the patient will have large impact of the patient’s perceived well-being. A nurse’s professional approach to palliative care is generally thought of as her taking on a compassionate role against her patients. The purpose of this paper was to describe the nurse’s experience of establishing and keeping a professional approach to her patients in palliative care. The study was conducted as a scientific literature review with a systematic gathering and scrutinizing of data. In total, eleven qualitative scientific articles were included in the review. Three main conclusions could be drawn. First, the nurses experienced that the relations within palliative care were characterized by closeness and emotional engagement. The close relationship between the nurse and her patients was regarded as being positive, although it constituted a risk of emotional overload. Second, it was found to be necessary for the nurse to maintain a professional distance to the patient to be able to separate work from private life. Third, many nurses identified a challenge of striking an appropriate balance between closeness and distance in order to be able to be personal without being private.

Postoperativ sårinfektion är en komplikation som var tionde patient drabbas av efter ett kirurgiskt ingrepp. Det medför inte bara lidande och förlängd vårdtid för patienten utan kan även vara direkt livshotande. Den förlängda vårdtiden medför dessutom kostnader för samhället, och resurser skulle kunna användas till annan vård. Syftet med litteraturstudien var att beskriva sådana omvårdnadsåtgärder som sjuksköterskan kan vidta för att förebygga postoperativa sårinfektioner. Evidensbaserade omvårdnadsåtgärder som, var för sig minskar risken för att patienten ska drabbas av en postoperativ sårinfektion, och tillsammans utgör grunden för en säker vård. Databassökning av vetenskapligt material inom området ligger till grund för resultatet. Genom aktuell forskning presenteras och lyfts olika omvårdnadsåtgärder som reducerar risken för patienten att drabbas av en postoperativ sårinfektion. Viktiga omvårdnadsåtgärder är: korrekt hårborttagning, bibehållen normotermi, dusch med desinfektion, glukoskontroll, administrering av antibiotikaprofylax och postoperativ sårvård. Ny forskning inom området efterfrågas för att kunna följa utvecklingen, eftersom den befintliga är publicerad för många år sedan. För att patienten ska kunna erbjudas en säker vård behövs kontinuerlig utbildning under sjuksköterskeutbildningen men även i den kliniska verksamheten. Regelbunden uppföljning och utvärdering bör också ske i den kliniska verksamheten för att omvårdnadsåtgärderna ska vara effektiva. / Postoperative surgical wound infection is a complication that every tenth patient suffering after a surgical procedure. The consequences are the suffering and prolonged length of stay for the patient and can also be directly fatal. The prolonged duration of treatment is a high cost in society and resources could be used for other care. The purpose of literature review was to describe nurse’s interventions, which can be taken to prevent postoperative surgical wound infections. Evidence-based care interventions which reduce the risk of the patients suffering a postoperative surgical wound infection and together they represent a safe care. The result is based on search in databases for scientific materials in the subject area. Through current research highlights interventions which reduce the risk of the patient suffering a postoperative wound infection. Essential nursing interventions which are identified as: Hair removal, warming, shower with disinfectant, glucose monitoring, administration of antibiotic prophylaxis and wound care. New research in this area is requested to follow the developments since the current research is getting old. If the care should be safe for patient there must be education in nursing training as well as in the clinical work. Continuous follow-up should also occur in the clinical work in order to get feedback if the nursing interventions are effective.

Submitted by Viviane Lima da Cunha (viviane@biblioteca.ufpb.br) on 2016-12-21T11:04:21Z No. of bitstreams: 1 arquivototal.pdf: 1750502 bytes, checksum: 1381e6089af8d21a0cfd4f0bd4f44d17 (MD5) / Made available in DSpace on 2016-12-21T11:04:21Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1750502 bytes, checksum: 1381e6089af8d21a0cfd4f0bd4f44d17 (MD5) Previous issue date: 2016-02-26 / Introduction: Literature describes four inherent dimensions in nursing work, such as: care, education, management and knowledge production, existing a connection between management and care, which shaped the concept of care management so as to actualize it by satisfying the patient’s needs, as well as the needs of the team and of the health facility. Objectives: To analyze the comprehension of nurses about nursing care management at the hospital environment; to address the occurrence of articulation and divergences between managing activities and direct care; and, to build a theoretical model which represents the nurses’ experience concerning care management. Method: Exploratory-descriptive study, of qualitative approach, based on the Grounded Theory as theoretical and methodological benchmark. The population participating in this study was composed of 12 nurses from a teaching hospital placed in João Pessoa-Paraíba. Data collection was carried out by means of the application of a questionnaire and a semi-structured interview. At the end of the process, the analysis proceeded to the identification of the phenomena and of the central category of the study. Results: Based on data analysis, two phenomena, which composed the discussion, were identified: 1 – Comprehending Nursing Care Management; 2 – Experiencing difficulties when developing Nursing Care Management. Discussion: It was sought to describe the professionals’ experience and knowledge about the topic, pointing out the difficulties they find in the practice of care management, and the strategies used and proposed to overcome these limitations before the performance of an integral and qualified care. From the interaction of these two phenomena, a central category of the study emerged: Experiencing nursing care management and adopting strategies to overcome difficulties in its practice. Conclusion: The professionals’ reports demonstrate the acknowledgement of the importance of care management to qualify the assistance, even though they run into personal and organizational difficulties to develop it. They, therefore, corroborate the relevance of the Systematization of Nursing Assistance (SAE), of the technical and scientific knowledge and of the communication, associated with qualification of interpersonal relations in order to obtain the actual knowledge of the patients’ care and health needs, working as the basis for assistance planning and, consequently, for the practice of a proper management of care. / Introdução: A literatura descreve quatro dimensões inerentes ao trabalho da Enfermagem: cuidado, educação, gerência e produção do conhecimento. Há uma conexão entre a gerência e o cuidado, a qual conformou o conceito de gerenciamento do cuidado, com vistas a efetivá-lo, através do atendimento às necessidades do paciente, da equipe e da instituição de saúde. Objetivos: Analisar como os enfermeiros compreendem o gerenciamento do cuidado de enfermagem no ambiente hospitalar; discorrer sobre a ocorrência de articulação e divergências entre as atividades gerenciais e o cuidado direto; e construir um modelo teórico que represente a vivência dos enfermeiros quanto ao gerenciamento do cuidado. Método: Estudo exploratório-descritivo, com abordagem qualitativa, guiado pela Teoria Fundamentada nos Dados, como referencial teórico e metodológico. A população participante do estudo constituiu-se de 12 enfermeiros de um hospital-escola, localizado em João Pessoa, Paraíba. Os dados foram coletados por meio da aplicação de questionário e de entrevista semiestruturada. No fim do processo, a análise prosseguiu com vistas a identificar os fenômenos e a categoria central do estudo. Resultados: Com base na análise dos dados, foram identificados dois fenômenos que compuseram as discussões do estudo: 1 – Compreendendo o gerenciamento do cuidado de enfermagem; 2 – Vivenciando dificuldades no desenvolvimento do gerenciamento do cuidado de enfermagem. Discussão: Procurou-se descrever a vivência e o conhecimento dos profissionais sobre a temática, apontando as dificuldades encontradas na prática do gerenciamento do cuidado e as estratégias utilizadas e propostas para a superação dessas limitações em relação ao desempenho de um cuidado integral e qualificado. Através da interação dos dois fenômenos, surgiu a categoria central do estudo: ‘Vivenciando o gerenciamento do cuidado de enfermagem’ e ‘Adotando estratégias para a superação das dificuldades em sua prática’. Conclusão: Os relatos dos profissionais demonstram o reconhecimento da importância do gerenciamento do cuidado para a qualificação da assistência, embora enfrentem dificuldades de ordem pessoal e organizacional para o seu desenvolvimento. Para tanto, evidenciam a relevância da SAE, do conhecimento técnico-científico e da comunicação, associados à qualificação das relações interpessoais, a fim de obter o conhecimento real das necessidades de cuidado e saúde dos pacientes, o que serve de base para o planejamento da assistência e, consequentemente, para a prática de um gerenciamento do cuidado adequado.

AFRIKAANS : Rasionaal: Die Suid-Afrikaanse konteks is heterogeen van aard en word gekenmerk deur ʼn kontinuum van ontwikkelende tot ontwikkelde gesondheidsdienste. Daar word beraam dat 55% van kinders (0-3 jaar) in landelike Suid-Afrikaanse gebiede woon, waar armoede heers en die infrastruktuur onvoldoende is. Die ongunstige omgewings omstandighede van talle kinders woonagtig in Suid-Afrika verhoog die risiko vir gestremdhede en plaas babas en kleuters in ʼn groter gevaar vir die ontwikkeling van ʼn kommunikasieafwyking, wat die behoefte aan effektiewe Vroeë Kommunikasie Intervensie (VKI) dienslewering in dié konteks beklemtoon. Primêre Gesondheidsorgklinieke (PGS) kan beskou word as die ideale konteks binne die Suid-Afrikaanse realiteit waar VKI programme en VKI dienslewering geïmplementeer kan word. Deur VKI dienslewering binne die Primêre Gesondheidsorgklinieke te implementeer, kan samewerkende dienslewering tussen VKI en Primêre Gesondheidsorg verhoog word. Beide die Primêre Gesondheidsorgmodel en die VKI benadering stel voorkoming en die vroeë identifikasie van afwykings as sentrale doelwit voor. Die implementering van VKI in die Suid-Afrikaanse Gesondheidsorgsisteem is deur talle navorsers geïdentifiseer as die wyse waarop die dienste aan babas en kleuters wat ʼn risiko toon vir die ontwikkeling van ʼn kommunikasieafwyking bevorder kan word. Deur die implementering van VKI dienslewering op die vlak van Primêre Gesondheidsorgklinieke, kan die basiese beginsels van VKI naamlik, dienslewering wat gemeenskapsgebaseerd, familie-gesentreerd, omvattend en gekoördineerd is, geïmplementeer word. Doel: Die hoofdoel van hierdie studie was om te bepaal in watter mate Gesondheidsorgklinieke in die Wes-Rand streek as konteks vir die toepassing van VKI kan dien. Metode: ʼn Beskrywende kwantitatiewe opname is as navorsingsontwerp vir beide fases benut. Ten einde die doel van die studie te bereik, is die navorsing in twee fases uitgevoer, omdat die navorsingsproses kronologiese verloop het en daar eerstens in fase een gefokus is op die konteks vir diensverskaffing, en tweedens in fase twee op die diensverskaffers. Fase een het ʼn konteks analise behels om sodoende die fisiese konteks waarbinne die sorggewers en hul kinders wat ʼn risiko vertoon vir die ontwikkeling van ʼn kommunikasieprobleem dienste ontvang, te beskryf en te evalueer deur die voltooiing van ʼn afmerklys wat vooraf deur die navorser opgestel is. Fase twee het ʼn triangulasie navorsingsmetode benut deur gebruik te maak van ʼn gestruktureerde onderhoudskedule, sowel as die voltooiing van ʼn opgestelde vraelys. Die afmerklys in fase een, die gestruktureerde onderhoudskedule, en die vraelys in fase twee het as data-insamelingstegnieke vir die navorsingsprojek gedien. Respondente en Deelnemers: Vir Fase 1 is 12 Primêre Gesondheidsorgklinieke in die drie sub-distrikte van die Wes-Rand distrik benut vir die konteksanalise. Vir Fase 2 is agt terapeute in hulle gemeenskapsdiensjaar wat werksaam is in die Wes-Rand distrik as deelnemers benut vir die bespreking van die vooraf geïdentifiseerde temas gedurende die gestruktureerde onderhoudskedule. 34 gemeenskapsverpleegkundiges van die Wes-Rand distrik is as respondente gebruik vir die voltooiing van die vraelys. Bevindinge: Die bevindinge het daarop gedui dat die Primêre Gesondheidsorgklinieke nie voldoende toegerus is vir die verskaffing van VKI dienslewering nie, ten spyte van die teenwoordigheid van risikofaktore onder die kliniekpopulasie. Verder was daar geen VKI bemarkings-, evaluasie- en intervensiemateriaal in die klinieke beskikbaar nie. Resultate het egter daarop gedui dat daar op ʼn weeklikse basis by elkeen van die Primêre Gesondheidsorgklinieke die moontlikheid bestaan van ʼn VKI span, aangesien daar ʼn spraak-taalterapeut, arbeidsterapeut, fisioterapeut, dieetkundige, maatskaplike werker, mediese dokter en verpleegkundige weekliks op dieselfde dag beskikbaar is. Die gemeenskapdiensjaarterapeute was positief ten opsigte van vroeë identifikasie en sekondêre voorkoming as sleutelkomponente van VKI. In teenstelling met die terapeute se positiwiteit t.o.v. vroeë identifikasie en voorkoming en in ooreenstemming met die bevindinge in Fase 1, was die terapeute van mening dat VKI tans nie suksesvol binne die Primêre Gesondheidsorgklinieke geïmplementeer sal kan word. Die gemeenskapsverpleegkundiges se kennis rakende VKI en aspekte wat verband hou met VKI was nie bevredigend nie. Die verpleegkundiges se houding jeens ʼn spanbenadering was positief, wat aan die spraak-taalterapeute die geleentheid bied om in samewerking met die verpleegkundiges die implementering van VKI binne hierdie konteks te motiveer en te implementeer. Gevolgtrekking: Die resultate van die navorsing hou implikasies in vir die rol van die spraak-taalterapeut ten opsigte van gemeenskapsgebaseerde intervensie, voorkoming, vroeë identifikasie, en die opleiding en bemagtiging van sorggewers en spanlede wat betref VKI binne die Suid-Afrikaanse Primêre Gesondheidsorgklinieke. Die behoefte aan verdere navorsing in die veld is deur die bevindinge van die studie beklemtoon. ENGLISH : Rationale: The South- African context is a heterogeneous context that is characterized by a continuum of developing to developed health care services. It is estimated that 55% of children (0 to 3 years) live in rural areas with insufficient infrastructure and under extreme conditions of poverty. Children living in South Africa are at greater risk for the development of a communication disorder due to the unfavourable environmental circumstances that they live in, which emphasizes the need for Early Communication Intervention (ECI) services in South Africa. Primary Health Care Clinics can be seen as the ideal context within South Africa where ECI programs and service delivery can be implemented. Both the Primary Health Care Model and the principles of ECI service delivery focuses on prevention and early identification of developmental disorders as their main goal. Many authors view the implementation of ECI in South Africa’s health system as the way in which the appropriate services can be provided to babies and infants that are at-risk for a communication disorder. Implementing ECI on the level of the Primary Healthcare will allow for the provision of services that are in accordance with the basic principles of service delivery stipulated by ASHA (1989), namely services that are community-based, family-centered, coordinated and comprehensive. Aim: The main purpose of the study was to determine the degree in which the Primary Health Care Clinics in the West-Rand district can be used for the implementation of Early Communication Intervention (ECI). Method: An exploratory, descriptive and contextual research design was implemented for both phases, which incorporated both quantitative and qualitative paradigms. This study was conducted in two phases. In Phase One a context analysis was conducted, where by a checklist was completed by the researcher, in order to describe and evaluate the context where children who are at risk for the development of a communication disorder, and their parents, may receive services. In Phase two a triangulation method was followed and the researcher made use of a structured interview to discuss the themes and a questionnaire in order to obtain information regarding the perception of the nurses and community service therapists on ECI services and the implementation of ECI services in the Primary Health Care Clinics. The checklist in phase one, the structured interview, and the questionnaire in phase two were used as data collection methods during this research project. Respondents and Participants: For the context analysis in Phase One, 12 Primary Health Care Clinics in the West-Rand district were used. Phase Two utilized 8 therapists as participants that were employed by the Wes-Rand health district to complete their community service year. 34 community nurses, employed by the West-Rand district were utilized as respondents and completed the questionnaire. Results: The findings of the study indicated that the Primary Health Care Clinics were not appropriately equipped for the implementation of ECI service delivery, despite the presence of risk-factors under babies and children visiting the clinics. There were no available ECI marketing-, assessment-, and intervention material at the clinics. It is promising to have found that there is the possibility of the implementation of an ECI team at each of the clinics, seeing that there is a speech-language therapist, occupational therapist, physiotherapist, dietician, social worker, medical doctor and nurse available on the same day on a weekly basis. The community service therapists were positive regarding early identification and the secondary prevention of communication disorders as key components of the ECI process. In contrast with their positive attitudes towards these aspects, they were of the opinion that due to proposed challenges in this context, at this stage, it will not be possible to implement the ECI process in the Primary Health Care Clinics. The community nurse’s knowledge regarding ECI and the aspects related to ECI were not appropriate. Despite this, they demonstrated a positive attitude towards the implementation of a team approach, which gives the speech-language therapist’s the opportunity to work with the nursing staff in a team approach, to implement ECI within the Primary Health Care Clinics. The participants in Phase Two were aware of the importance of ECI and the need for ECI services in this context, but they were of the opinion that the implementation of ECI in this Primary Health Care Context would not be possible due to a variety of reasons. The respondents in Phase Two demonstrated inappropriate knowledge and awareness regarding ECI, communication development, communication disorders and the role of the speech-language therapist and audiologist in the Primary Health Care Context. The majority of the respondents were positive about in-service ECI training, regardless of their limited knowledge thereof. Conclusion: The results have implications for the role of the speech-language therapist in terms of community-based intervention, prevention, early identification, parent training and informing colleagues about ECI within the South African Primary Health Care Clinics. The need for further research in this field is emphasized. Copyright / Dissertation (MComm Path)--University of Pretoria, 2009. / Speech-Language Pathology and Audiology / Unrestricted

Cette recherche qualitative identifie le rôle de l’expérience face à l’intuition et à l’émotion dans la décision clinique de l’infirmière d’accueil et d’orientation des urgences hospitalières. La problématique du rôle triple de l’expérience sur le raisonnement, sur la nature et le contrôle du « ressenti » éprouvé dans le feu de l’action est étudiée au travers de l’influence de la posture de connaissance face à l’expérience induisant l’acquisition et l’usage de savoirs explicites et implicites (Dewey, 2004) agissant sur le modèle opératif de pensée d’un professionnel (Pastré, 2011). La méthodologie, orientée par une posture théorique multi référentielle (Ardoino,1986), articule les approches de la décision en économie (Simon, 1983), en neurosciences (Berthoz, 2003 ; Damasio, 1995) avec les travaux sur l’intuition dans la pensée bi-systémique (Kahneman, 2016) et les approches du rôle cognitif des émotions (Livet, 2002 ; Rimé, 2009, Thievenaz, 2017). Des entretiens semi-directifs et d’explicitation (Vermersch, 1994) sont conduits auprès de vingt infirmiers-ères, de deux hôpitaux.Six propositions théoriques émanent des résultats. L’existence d’une posture « cognitivo-émotionnelle » face à l’expérience vécue dans l’action est découverte. Elle génère un mode et des modalités de raisonnement et d’élaboration d’indicateurs cliniques ou de savoirs d’action mais aussi un mode décisionnel à partir du vécu de l’expérience. Elle influence la nature « ressenti » qui est intuition ou émotion ou étonnement. Selon sa posture, l’infirmière cherche à confirmer son intuition. Elle cherche des preuves à son étonnement, régule son émotion ou renonce à prendre une décision, ou se protège de tout « ressenti ». / This doctoral thesis’ research identifies the roles of experience in the effects of intuition or emotion and clinical reasoning and characterizes the nature of the “feeling” rising; The “multiréférentiel” (Ardoino, 1986)theoretical and methodological framework links a pragmatist understanding of implicit or explicit experiential learning’s through an active or passive knowing posture (Dewey, 2004) with theoretical works concerning the decision processing in economics (Simon, 1983), in neurosciences (Berthoz, 2003; Damasio, 1995) and with the cognitive function of emotion (Livet, 2002;Rimé, 2009). Intuition is replaced in dual process theories of cognition (Kahneman, 2016). Data were collected from two French Parisian emergency’s departments through twenty emergency nurses differently experienced in triage, volunteered to take part in the study,. Semistructured interview collected the nurses’posture of knowing. “Elicitation interviews’” (Vermersch, 1994)recalled nurses’ thinking procedures in the heat of the moment and shows how nurses’ control their “feeling” and the set of the contextual determinants. Six theoretical propositions derived from the findings. During the patient’s examination and the clinical reasoning process, nurses adopt a particular “cognitive – emotional”posture of knowing and reflective thinking. This posture has an impact on the control of the nurse’s feeling andof the nature of what she felt and on the decision type. Depending of her posture, nurses will take into account her “feeling” or not. A negative emotion stops the decision making process. Intuition involves the search of additional fact or clues or clinical signs. The cognitive uncertainty induces a specific inquiry. The nurses’ “feeling’’ empirically characterize is an intuition, an emotion, an uncertainty.

Bakgrund: Patienter och anhöriga vill ha själsligt stöd från sjuksköterskor när patienter vårdas i livet slut. Sjuksköterskans stöd kan visas genom samtal, tydlig kommunikation, empati, förståelsen att utföra religiösa ritualer och viljan att finnas till för patienten och dess anhöriga. Problemformulering: Tidigare forskning visar också att patienter och anhöriga är i behov av själsligt stöd från sjuksköterskorna. Sjuksköterskans erfarenheter av att ge själslig omvårdnad bör undersökas för att skapa ytterligare kunskaper inom ämnet. Syfte: Syftet är att beskriva sjuksköterskors erfarenheter av att ge själslig omvårdnad till patienter vid livets slut. Metod: En allmän litteraturöversikt utfördes. Sju kvalitativa och tre kvantitativa artiklar granskades. Artiklarna söktes fram i databaserna Cinahl+ och PubMed. Resultat: Majoriteten av sjuksköterskorna var eniga om att utbildning inom själslig omvårdnad var nödvändig för att utveckla kunskapen om omvårdnad vid livets slut. Exempel på brister som sjuksköterskorna kunde se inom den själsliga omvårdnaden var brist på kunskap, brist på vilja, rädsla och tidsbrist. Sjuksköterskorna ansåg att själsligt stöd var viktigt för både patient och anhöriga. Slutsats: Ytterligare forskning inom området krävs för att bredda sjuksköterskors kunskap om själslig omvårdnad vid livets slut.Vidareutbildningsinsatser inom ämnet bör utvecklas och implementeras i omvårdnaden. / Background: Patients and their relatives want to receive more soul support when patients receive end of life care. Nurses support can be shown through conversation, clear communication, empathy, understanding religious rituals and the will to be there for the patients and their relatives. Problem: Previous research shows that patients and their relatives need soul support from nurses. Nurses experiences of giving soul support needs to be examined to create further knowledge. Purpose: The purpose is to describe nurses’ experiences of giving soul support to patients with end of life care. Method: A general literature review was performed. Seven qualitative and three quantitative articles were reviewed. The articles were searched in Cinahl+ and PubMed. Result: Most of the nurses agreed that further education in soul care was needed to evolve knowledge about end of life care. Examples of shortcomings that the nurses could see in soul care was lack of knowledge, lack of will, fear, and lack of time. The nurses feel that soul care is important for both the patient and their relatives. Conclusion: Further research is needed to broaden the knowledge of soul support in end of life care for nurses. Further education in the subject should be developed and implemented in the care.

Bakgrund: Palliativ vård ges i livets slutskede när botande behandling inte längre är möjlig. På grund av sjukdomen kan patienten förlora sin självständighet och frihet, vilket leder till att livet inte fungerar som tidigare. Sjuksköterskans ansvar är att lindra patienters lidande under sista tiden i livet samt att uppfylla behov hos närstående. För att främja patientens livskvalitet bör sjuksköterskan dessutom skapa en god relation med den döende och dess närstående. Patienten och närstående uttrycker att sjuksköterskan bör ta ansvar för kommunikation, information och existentiella samtal i palliativ vård. Syfte: Att beskriva sjuksköterskors upplevelser av palliativ vård i livets slut skede på sjukhus. Metod: Examensarbetet är utformat enligt en systematisk litteraturstudie med kvalitativ beskrivande syntes. Resultat: Utifrån dataanalysen framkommer två teman: hinder för god palliativ vård och emotionell påverkan. Dessa innefattar subteman och beskriver sjuksköterskors upplevelser av palliativ vård. Slutsats: Brist på erfarenhet, kunskap och tid hindrar sjuksköterskor att ge en god palliativ vård. Kommunikation, samarbete med kollegor, patienten och närstående samt emotionellt engagemang och möjlighet för existentiella samtal ansågs angelägna i palliativ vård. Nyckelord: kvalitativ, litteraturstudie, livets slutskede, palliativ vård, sjuksköterskors upplevelser. / Background: Palliative care is provided at the end of life when curative treatment is no longer possible. Due to the disease, the patient may lose his independence and freedom, which leads to life not functioning as before. The nurse's responsibility is to alleviate patients' suffering during the last period of life and to meet the needs of relatives. In order to promote the patient's quality of life, the nurse should also create a good relationship with the dying person and their relatives. The patient and relatives express that the nurse should take responsibility for communication, information and existential conversations in palliative care. Aim: To describe nurses' experiences of palliative care at the end of life stage in hospital. Method: The study is a systematic literature study with qualitative and descriptive synthesis. Results: After the data analysis, three themes emerged: barriers to providing good palliative care and emotional influences. These include sub-themes and describe nurses' experiences of palliative care. Conclusion: Lack of experience, knowledge and time prevents nurses from providing good palliative care. Communication, collaboration with colleagues, the patient and relatives, as well as emotional commitment and the opportunity for existential conversations were considered important in palliative care. Keywords: end of life, literature study, nurse’s experiences, palliative care, qualitative.

Bakgrund: Behandlingen av bakteriella infektioner med antibiotika har lett till ett ökat problem av antibiotikaresistens. Antibiotikaresistensens konsekvenser har resulterat i problem för både individer och sjukvård världen över. Både etiska aspekter och sjuksköterskans roll inom omvårdnaden behöver ses över för att finna lösningar till detta globala hot.   Syfte: Att beskriva sjuksköterskans förebyggande roll vid antibiotikaresistens.  Metod: En litteraturöversikt   Resultat: Sjuksköterskans roll i förebyggandet av antibiotikaresistens ansågs var otydliga. Sjuksköterskor belyste att utbildningen innehöll moment om förebyggande åtgärder för antibiotika resistens lika så i praktiken. Däremot upplevde sjuksköterskor i arbetslivet att de var exkluderade.   Sammanfattning: Författarna fann att det fanns en tydlig koppling mellan betydelsen av sjuksköterskans arbetsroll och det förebyggande arbetet kring antibiotikaresistens. Det fanns även en kunskapsbrist hos sjuksköterskorna kring antibiotikaresistensen och de förebyggande rutinerna samt att vikten av en fungerande kommunikation mellan vårdprofessionerna spelade stor roll. / Background: The treatment of bacterial infections with antibiotics has led to an increased problem with antibiotic resistance. The antibiotic resistance has had consequences that resulted in problems for both individuals as well as health care worldwide. Both ethical aspects and the nurse’s role within nursing needs to be reviewed to find solutions to this global threat.   Aim: To describe the nurse’s preventive roll in antibiotic resistance.  Method: Literature review  Results: The nurse’s role in the prevention of antibiotic resistance was seen as vague. Nurses illustrated that education contained elements on the prevention of antibiotic resistance as well as in practice. On the other hand, in the work life, nurses rather felt that they were excluded.   Summary: The authors found that there was a clear connection between the importance of the nurse’s work role and the preventative work regarding antibiotic resistance. There was a knowledge gap between the nurses when it came to antibiotic resistance and the preventative routines as well as bearing that a functioning communication between the nursing professions was of big importance.

Bakgrund Våld mot kvinnor i nära relationer är ett stort globalt samhällsproblem där kvinnorna oftare utsätts för grövre våld än män. Det är viktigt att uppmärksamma och motarbeta alla former av våld i nära relationer, oavsett om det handlar om psykiskt, fysiskt, sexuellt, ekonomiskt eller materiellt våld. Våldsutsatta kvinnor söker sig oftare till hälso- och sjukvården för varierande åkommor därför är det av stor vikt att sjuksköterskor är observanta och lyhörda på signaler och andra tecken på utsatthet och att man som sjuksköterska vågar fråga för att kunna fånga upp dessa kvinnor och sedan stödja dem att bryta deras destruktiva relationer. Syfte Syftet med litteraturöversikten var att belysa sjuksköterskors upplevelse av att vårda kvinnor som upplevt våld i nära relationer. Metod Denna litteraturöversikt grundar sig på 11 noga utvalda vetenskapliga orginalartiklar varav åtta är kvalitativa och tre är kvantitativa. Databassökningen genomfördes i Cinahl Complete, PubMed och PsycInfo. Resultat Litteraturöversikten ledde fram till tre teman. I det första temat med två subteman beskrevs organisatoriska barriärer som äventyrade sjuksköterskors bemötande inklusive bristfälliga rutiner/riktlinjer, samt bristfälliga utbildningar för sjuksköterskor. Det påvisade brister på organisationsnivå där sjuksköterskor saknade både rutiner om tydliga riktlinjer och detta i sin tur kunde äventyra patientsäkerheten. Tema två speglar sjuksköterskors erfarenheter och uppfattning sjuksköterskerollen i förhållande till de våldsutsatta kvinnorna. Tema tre behandlar sjuksköterskors emotionella upplevelser av att vårda dessa kvinnor. Slutsats Sjuksköterskors upplevelse av att bemöta kvinnor som utsatts för våld i nära relationer var begränsade. För att sjuksköterskor i sin profession skall kunna utföra adekvat omvårdnad behövs tydliga instruktioner och riktlinjer samt fortlöpande utbildningar. Sjuksköterskors förhållningsätt och synsätt hade också en betydande roll hur de bemötte dessa kvinnor. / Background Violence against women in close relationships is a major global social problem where women often are exposed to more severe violence than men. It is important to draw attention to and combat all forms of violence in close relationships, whether it is psychological, physical, sexual, economic, or material violence. Women who have experienced violence often seek out healthcare services for various conditions, which is why it is of great importance that nurses are observant and attentive to signals and other signs of abuse, and that as a nurse, you dare to ask in order to identify these women and then support them in breaking their destructive relationships. Aim The aim of the literature review was to explore nurses' experience of caring for women that had experienced violence in intimate relationships. Method This literature review is based on 11 selected original scientific articles, of which eight were qualitative and three were quantitative. The database search was conducted in Cinahl Complete, PubMed and PsycInfo. Results The literature review led to three themes. In the first theme with two subthemes, organizational barriers that influenced the nurses' care of the women were described, including inadequate routines/guidelines and inadequate training for nurses. It demonstrated deficiencies at the organizational level where nurses lacked both routines and clear guidelines, and this in turn could endanger patient safety. Theme two reflects how the nurses' interpreted the nursing role in relation to these women. Theme three involves nurses' emotional experiences of caring for women who have been exposed to violence in close relationships. Summary The result showed that nurses' experiences of caring for women who have been exposed to violence in close relationships were limited. In order for nurses in their profession to be able to perform adequate care, clear instructions and guidelines as well as ongoing training are needed. Nurses' attitudes and viewpoints also had a significant role in how they treated the women who had experienced violence in close relationship.

Title: Nurses’ experiences of health promotion to patients with diabetes type 2 in VietnamBackground: Diabetes is one of the seven major causes leading to death and disability in Vietnam. In the year 2021 the amount of people aged 20-79 with diabetes in Vietnam were 3.9 million, which is equal to 6.1% of Vietnam’s population. Health promotion is a central part of nursing and is the process of enabling people to increase control over, and to improve their health. Person centered care is defined as to promote health based on how the individual person perceives health and sickness.Aim: Investigate Vietnamese nurses’ experiences of health promotion to patients with diabetes type 2.  Method: A qualitative design with an inductive approach. Nine nurses have been interviewed at one hospital in Vietnam through semi-structured interviews. Result: Three main categories, 1. Experiences of the importance of knowledge about health promotion, 2. Experiences of the importance of support to the patients to promote health, 3. Experiences of health promotion through educating and informing the patientConclusion: The Vietnamese nurses explained their knowledge and experiences of health promotion to patients with diabetes mellitus type 2 (DM2), which included educating, supporting, and informing the patients. Vietnamese nurses have a need for more knowledge about health promotion. / Titel: Sjuksköterskors erfarenheter av att arbeta hälsofrämjande med diabetes typ 2 i Vietnam.Bakgrund: Diabetes är en utav de sju främsta anledningarna till dödsfall och funktionsnedsättning i Vietnam. År 2021 var 3.9 miljoner i åldrarna 20–79 diagnostiserade med diabetes, vilket motsvarar 6.1% utav Vietnams population.  Hälsofrämjande arbete är en utav sjuksköterskans främsta arbetsuppgifter och innebär möjliggörandet för individer att öka kontrollen över samt förbättra sin hälsa. Personcentrerad omvårdnad beskrivs som att anpassa och främja hälsa utifrån hur den enskilde individen uppfattar hälsa och sjukdom. Syfte: Undersöka vietnamesiska sjuksköterskors erfarenheter av att arbeta hälsofrämjande för patienter med diabetes typ 2.Metod: En kvalitativ design med en induktiv ansats. Nio sjuksköterskor har intervjuats på ett sjukhus i Vietnam genom semistrukturerade intervjuer.Resultat: Tre huvudkategorier, 1. Erfarenheter av vikten av kunskap om hälsofrämjande arbete, 2. Erfarenheter av vikten av att främja hälsa genom att stödja patienten, 3. Erfarenheter av att främja hälsa genom att undervisa och informera patienten.Slutsats: De vietnamesiska sjuksköterskorna beskrev deras kunskap och erfarenheter om hälsofrämjande arbete med diabetes mellitus typ 2 (DM2), som inkluderade undervisning, att ge support och att informera patienterna. Vietnamesiska sjuksköterskor har behov av mer kunskap om hälsofrämjande arbete.