Background: Multiple sclerosis (MS) is a chronic neurological autoimmune disease. The disease affects most young people between 20-40 years of age, mainly women. There are about 2.5 million people worldwide are affected by MS. The most common symptoms that a patient with MS suffers from are the fatigue (tiredness), pain, depression, sleep disturbance, balance disorder, dizziness, palsies (paralysis) and heat intolerance. There are also other physical and mental dysfunctions. Aim: The purpose of this study was to describe patients' experiences of MS disease symptoms and the nurse's possible role in disease progression. Method: A literature study based on nine scientific articles. Articles were searched in the databases CINAHL and PubMed in the fall 2015th.   Results: This study showed how the experiences of the symptoms for patients with MS affected their health, social life and quality of life in a negative way. The study also showed that nurses have an important informative, supportive and integrated role for the patient and family, during the course of the disease. Conclusions: MS disease affects the sufferer's life in a negative way, both physically and mentally. The disease usually means that the patient is facing uncertain and unpredictable future, and suffers unpleasant symptoms. These experiences involve not only a part of the body but the whole person. The assistance of the care and especially the nurse is of great importance to facilitate the patient's situation and help the patient to preserve their quality of life as good as possible. The nurses’ informative and caring role is a great support to patients with MS. Better understanding of patients' experience can be valuable for a better communication and care.

Då sexualiteten är en integrerad del av varje människas liv hör det till sjuksköterskans ansvarsområde att tala om ämnet med patienten för att kunna bedriva en holistisk vård. Flertalet sjukdomar och behandlingar kan ha en inverkan på patientens sexualitet. Många patienter känner ett behov av att kommunicera kring detta ämne, trots det är sexualitet ett område som ofta undviks av sjuksköterskan. Det är därför av vikt att undersöka varför det är så och vilka faktorer som främjar sjuksköterskans kommunikation kring sexualitet. Därför var syftet att belysa vad som hämmar och främjar sjuksköterskans kommunikation kring sexualitet med patienten. Arbetet utfördes som en litteraturstudie där 12 vetenskapliga artiklar analyserades för att finna hämmande och främjande faktorer. Dessa faktorer låg sedan till grund för resultatet. I resultatet framgick att sjuksköterskans utbildning, ålder, kön, yrkeserfarenhet och känslor inför sexualitet var faktorer som både kunde hämma och främja sjuksköterskans kommunikation kring sexualitet med patienten. Arbetsplatsen har också en betydelse för huruvida sjuksköterskan samtalar med patienten om ämnet. Även kulturella skillnader mellan sjuksköterska och patient påverkade samtal om sexualitet. Sexualitetens inverkan på hälsan bör belysas redan i grundutbildningen och sedan genom fortbildning på arbetsplatsen. Tydliga riktlinjer på arbetsplatsen och mer djupgående forskning krävs för att sjuksköterskan i framtiden ska kunna tala mer öppet om sexualitet. / As sexuality is an integrated part of every person’s life and it is the nurse’s responsibility to talk about the subject with the patient in order to conduct a holistic health care. Many diseases and treatments may impact the patient’s sexuality. Most patients feel the need to communicate regarding this subject, but still sexuality is an area that the nurse often avoids. It is therefore important to examine why this is so and what factors promote the nurse's communication regarding sexuality. Therefore, the aim was to highlight what inhibits and promotes the nurse's communication regarding sexuality with the patient. The work was carried out as a literature study where 12 scientific articles were analyzed in order to identify inhibiting and promoting factors. These factors formed the basis for the result. The results showed that the nurse's education, age, gender, work experience and feelings about sexuality were factors that could both inhibit and promote the nurse's communication regarding sexuality with the patient. The workplace also has bearing on whether or not the nurse talks to the patient about the subject. Cultural differences between nurse and patient also affected the conversation about sexuality. Sexuality's impact on health should be elucidated in the nurse education and then through training in the workplace. Clear guidelines and more in-depth research is needed to promote nurses in the future to speak more openly about sexuality.

This qualitative descriptive research study was undertaken to describe the experiences of emergency nurses with critical incidents and identify strategies used to manage these situations in the emergency department setting. Critical incidents are events, such as death or serious injury, that cause a strong emotional reaction and may overwhelm a nurse‘s usual coping skills. Nineteen nurses who worked in one of two community-based emergency departments in Central Massachusetts were interviewed and asked to describe a critical incident they had experienced in their nursing career. Qualitative content analysis revealed two major themes: (1) critical incident experiences; and (2) aftermath; and five subthemes: (a) connections; (b) workplace culture; (c) responses; (d) lasting effects; and (e) strategies. Critical incidents were limited to events with children, patient deaths, and interactions with family; this differed from prior research in that no incidents were identified involving multiple casualties, violence, or mutilating injuries. Connections occurred when the patient was known to the nurse or reminded the nurse of self or family. Responses were the reactions of the participants to the critical incident and were physical, psychological, and spiritual in nature. The majority of study participants cried in response to a critical incident. Workplace culture, a subtheme not found in other studies, involved their perceptions of expected behavior in the emergency department and emphasized the influence of workplace culture on newer or inexperienced nurses. The theme of aftermath described the time period following critical incident. Lasting effects occurred in the form of vivid memories that were triggered by different stimuli. The subtheme, strategies, revealed that nurses desired, but lacked formal strategies to manage their reactions following a critical incident. Thus, they described the use of informal strategies such as talking to co-workers and family members. Implications of this study support the need for educational preparation and support of emergency nurses who deal with critical incidents in the workplace. Intervening during the critical incident experience and having follow-up strategies in place to prevent distress and enhance coping in the aftermath are important for well-being, practice, and patient care in the emergency setting.

Bakgrund: Patienter riskerar att försämras i sitt tillstånd på grund av olika faktorer. Sjuksköterskan har en viktig roll i att upptäcka, bedöma och initiera åtgärder för en patient som försämras i sitt tillstånd. Sjuksköterskans kompetens består av kunskap, färdigheter och erfarenheter. Sjuksköterskan ska arbeta för att säkerställa patientsäkerheten inom vården. Syfte: Syftet var att belysa hur sjuksköterskans kompetens kan påverka patientsäkerheten vid försämring av patientens tillstånd. Metod: En litteraturstudie genomfördes genom att söka i relevanta databaser. Elva artiklar valdes ut och bearbetades med inspiration från innehållsanalys. Resultat: Fyra kategorier med tillhörande underkategorier framkom. Huvudkategorierna var: Från sjuksköterskestudent till nyutbildad sjuksköterska, Den yrkeskompetenta sjuksköterskan, Samverkan i vårdteam och Arbetsmiljöns betydelse. Nyutbildade sjuksköterskor upplevde att de hade brist på erfarenhet i att hantera patienter som försämras i sitt tillstånd. Erfarenhet och kontinuitet framkom som betydande för att upptäcka och hantera försämring i patientens tillstånd. Samarbete ökade patientsäkerheten men det förekom brister i kommunikationen mellan läkare och sjuksköterska. Slutsats: Litteraturstudien påvisade att sjuksköterskans kompetens påverkar patientsäkerheten vid försämring av patientens tillstånd. Mer forskning behövs för att undersöka hur detta kan tillämpas inom vården. / Background: Nurses have an important role in recognizing and responding to patient deterioration. Nursing competence includes knowledge, skills and experience. The nurse must work to ensure patient safety in healthcare. Aim: The aim of this study was to illustrate how nursing competence affects patient safety during patient deterioration. Method: A literature study was undertaken by searching relevant databases. Eleven articles were selected and analyzed with inspiration from content analysis. Results: Four main categories with associated subcategories emerged. The main categories were From nursing student to newly graduated nurse, The professional and competent nurse, Teamwork and The importance of the working environment. Newly graduated nurses felt they lacked experience when dealing with patient deterioration. Experience and continuity played an important role for nurses when dealing with deterioration. Team collaboration increased patient safety, but there were shortcomings in communication between nurses and doctors. Conclusion: The literary study showed that nursing competence affects patient safety when a patient deteriorates. Further research is needed to establish how this information can be applied in healthcare.

Este estudo foi de natureza qualitativa e utilizou como referencial teórico o Interacionismo simbólico e metodológico a Teoria Fundamentada em Dados. Objetivou-se desenvolver um modelo de cuidado espiritual para os pacientes e seus familiares no enfrentamento de situações de adoecimento. O estudo foi realizado em Hospital Universitário do sul do Brasil, com seis enfermeiras e quatro técnicas de enfermagem, com um ano ou mais de experiência na área de atuação e que estavam exercendo suas atividades. Para coleta dos dados utilizou-se uma entrevista semiestruturada do tipo intensivo e um grupo de expertise, com quatro participantes para validação do Modelo, no período de março a maio de 2016. Os preceitos éticos foram seguidos e obtidas as assinaturas de todas as participantes no Termo de Consentimento Livre e Esclarecido. A coleta e análise dos dados ocorreram de forma concomitante de acordo com o método. Na análise dos dados aplicaram-se as etapas da Teoria Fundamentada em Dados que prevê a codificação inicial, focalizada, axial e teórica. Os significados, pressupostos, ações e resultantes identificados a partir das experiências e vivências das participantes no cuidado aos pacientes e seus familiares foram descritas nas categorias Situando a espiritualidade no seu viver e as subcategorias “Reconhecendo a espiritualidade como uma necessidade e complemento” e “Caminhando na espiritualidade”. Exercitando a espiritualidade na vida e as subcategorias “Praticando a espiritualidade ao seu modo”, “Percebendo a espiritualidade como uma opção de vida”, “Respeitando as crenças do outro”, “Encontrando a espiritualidade na maneira de agir e pensar”. Percebendo o papel da equipe de enfermagem no cuidado espiritual e as subcategorias “Advogando os direitos do paciente e em prol da profissão”, “Conversando sobre espiritualidade”, “Preparando a equipe de enfermagem”, “Cuidando no processo e morte e morrer”, “Limitando o cuidado pelas crenças pessoais, organizacionais e religiosas”. Identificando as manifestações das necessidades espirituais e as subcategorias “Identificando as formas de enfrentamento do sofrimento” e “Acontecendo: o momento de atender as necessidades”. Colocando a espiritualidade como prioridade no cuidado e as subcategorias “Acolhendo os pacientes e familiares”, “Utilizando práticas integrativas”, “Rezando com o paciente”, “Confortando por meio da espiritualidade” e “Continuando a acreditar todos os dias”. A integração destas categorias possibilitou identificar a categoria central Ressignificando o adoecimento e o desenvolvimento do modelo de cuidado espiritual. Além disso, foi desenvolvida uma versão prática do modelo. O estudo originou uma compreensão e interpretação conceitual e prática sobre o tema espiritualidade na enfermagem e foram delineadas as conexões entre a equipe de enfermagem e os pacientes e familiares no momento do cuidado espiritual. / This study was a qualitative approach, which used the theoretical symbolic interactionism and the Grounded Theory as methodological benchmarks. The purpose was to develop a spiritual model of care for patients and their relatives when confronting situations of illness. The study was conducted in a University Hospital in the south of Brazil and involved six nurses and four certified nurse practitioner, whose had one year or over of experience in the operating area and were performing their activities. In order to collect data, we used semi-structured interviews of intensive type and an expertise group, composed of four participants, with sights to validate the Model, during the period between March and May 2016. The ethical precepts were followed, and then we obtained the signatures of all participants in the Free and Informed Consent Form. The collection and analysis of data took place concomitantly in line with the method. When analyzing data, we applied the steps of the Grounded Theory, which foresees the initial, focused, axial and theoretical coding. The meanings, assumptions, actions and outcomes identified from the experiences and backgrounds of the participants in the care of patients and their relatives were described in the categories “Situating the spirituality in your daily life” and the subcategories “Recognizing the spirituality as a need and complement” and “Walking in the spirituality”. “Exercising the spirituality in life” and the subcategories “Practicing the spirituality in my own way”, “Perceiving the spirituality as a life choice”, “Respecting the beliefs of others”, Finding the spirituality in the way of acting and thinking”. “Perceiving the role of the nursing team in the spiritual care” and the subcategories “Advocating the patient’s rights and for the promotion of the profession”, “Talking about spirituality”, “Preparing the nursing team”, “Caring for in the process of death and dying”, “Limiting care through the personal, organizational and religious beliefs”. “Identifying the manifestations of the spiritual needs” and the subcategories “Identifying the ways of confronting the suffering” and “Happening: the time to meet the needs”. “Placing the spirituality as a priority in the care” and the subcategories “Welcoming the patients and relatives”, “Using integrative practices”, “Praying together with the patient”, “Comforting through the spirituality” and “Continuing to believe every day”. The integration of these categories has enabled us to identify the central category “Resignifying the illness”, as well as to develop a spiritual care model. In addition, we have developed a practical version of the model. The study gave rise to a practical and conceptual understanding and interpretation about the issue of spirituality in nursing, and then we drew up the connections between the nursing team and the patients and their relatives at the time of the spiritual care.

Este estudo foi de natureza qualitativa e utilizou como referencial teórico o Interacionismo simbólico e metodológico a Teoria Fundamentada em Dados. Objetivou-se desenvolver um modelo de cuidado espiritual para os pacientes e seus familiares no enfrentamento de situações de adoecimento. O estudo foi realizado em Hospital Universitário do sul do Brasil, com seis enfermeiras e quatro técnicas de enfermagem, com um ano ou mais de experiência na área de atuação e que estavam exercendo suas atividades. Para coleta dos dados utilizou-se uma entrevista semiestruturada do tipo intensivo e um grupo de expertise, com quatro participantes para validação do Modelo, no período de março a maio de 2016. Os preceitos éticos foram seguidos e obtidas as assinaturas de todas as participantes no Termo de Consentimento Livre e Esclarecido. A coleta e análise dos dados ocorreram de forma concomitante de acordo com o método. Na análise dos dados aplicaram-se as etapas da Teoria Fundamentada em Dados que prevê a codificação inicial, focalizada, axial e teórica. Os significados, pressupostos, ações e resultantes identificados a partir das experiências e vivências das participantes no cuidado aos pacientes e seus familiares foram descritas nas categorias Situando a espiritualidade no seu viver e as subcategorias “Reconhecendo a espiritualidade como uma necessidade e complemento” e “Caminhando na espiritualidade”. Exercitando a espiritualidade na vida e as subcategorias “Praticando a espiritualidade ao seu modo”, “Percebendo a espiritualidade como uma opção de vida”, “Respeitando as crenças do outro”, “Encontrando a espiritualidade na maneira de agir e pensar”. Percebendo o papel da equipe de enfermagem no cuidado espiritual e as subcategorias “Advogando os direitos do paciente e em prol da profissão”, “Conversando sobre espiritualidade”, “Preparando a equipe de enfermagem”, “Cuidando no processo e morte e morrer”, “Limitando o cuidado pelas crenças pessoais, organizacionais e religiosas”. Identificando as manifestações das necessidades espirituais e as subcategorias “Identificando as formas de enfrentamento do sofrimento” e “Acontecendo: o momento de atender as necessidades”. Colocando a espiritualidade como prioridade no cuidado e as subcategorias “Acolhendo os pacientes e familiares”, “Utilizando práticas integrativas”, “Rezando com o paciente”, “Confortando por meio da espiritualidade” e “Continuando a acreditar todos os dias”. A integração destas categorias possibilitou identificar a categoria central Ressignificando o adoecimento e o desenvolvimento do modelo de cuidado espiritual. Além disso, foi desenvolvida uma versão prática do modelo. O estudo originou uma compreensão e interpretação conceitual e prática sobre o tema espiritualidade na enfermagem e foram delineadas as conexões entre a equipe de enfermagem e os pacientes e familiares no momento do cuidado espiritual. / This study was a qualitative approach, which used the theoretical symbolic interactionism and the Grounded Theory as methodological benchmarks. The purpose was to develop a spiritual model of care for patients and their relatives when confronting situations of illness. The study was conducted in a University Hospital in the south of Brazil and involved six nurses and four certified nurse practitioner, whose had one year or over of experience in the operating area and were performing their activities. In order to collect data, we used semi-structured interviews of intensive type and an expertise group, composed of four participants, with sights to validate the Model, during the period between March and May 2016. The ethical precepts were followed, and then we obtained the signatures of all participants in the Free and Informed Consent Form. The collection and analysis of data took place concomitantly in line with the method. When analyzing data, we applied the steps of the Grounded Theory, which foresees the initial, focused, axial and theoretical coding. The meanings, assumptions, actions and outcomes identified from the experiences and backgrounds of the participants in the care of patients and their relatives were described in the categories “Situating the spirituality in your daily life” and the subcategories “Recognizing the spirituality as a need and complement” and “Walking in the spirituality”. “Exercising the spirituality in life” and the subcategories “Practicing the spirituality in my own way”, “Perceiving the spirituality as a life choice”, “Respecting the beliefs of others”, Finding the spirituality in the way of acting and thinking”. “Perceiving the role of the nursing team in the spiritual care” and the subcategories “Advocating the patient’s rights and for the promotion of the profession”, “Talking about spirituality”, “Preparing the nursing team”, “Caring for in the process of death and dying”, “Limiting care through the personal, organizational and religious beliefs”. “Identifying the manifestations of the spiritual needs” and the subcategories “Identifying the ways of confronting the suffering” and “Happening: the time to meet the needs”. “Placing the spirituality as a priority in the care” and the subcategories “Welcoming the patients and relatives”, “Using integrative practices”, “Praying together with the patient”, “Comforting through the spirituality” and “Continuing to believe every day”. The integration of these categories has enabled us to identify the central category “Resignifying the illness”, as well as to develop a spiritual care model. In addition, we have developed a practical version of the model. The study gave rise to a practical and conceptual understanding and interpretation about the issue of spirituality in nursing, and then we drew up the connections between the nursing team and the patients and their relatives at the time of the spiritual care.

Este estudo foi de natureza qualitativa e utilizou como referencial teórico o Interacionismo simbólico e metodológico a Teoria Fundamentada em Dados. Objetivou-se desenvolver um modelo de cuidado espiritual para os pacientes e seus familiares no enfrentamento de situações de adoecimento. O estudo foi realizado em Hospital Universitário do sul do Brasil, com seis enfermeiras e quatro técnicas de enfermagem, com um ano ou mais de experiência na área de atuação e que estavam exercendo suas atividades. Para coleta dos dados utilizou-se uma entrevista semiestruturada do tipo intensivo e um grupo de expertise, com quatro participantes para validação do Modelo, no período de março a maio de 2016. Os preceitos éticos foram seguidos e obtidas as assinaturas de todas as participantes no Termo de Consentimento Livre e Esclarecido. A coleta e análise dos dados ocorreram de forma concomitante de acordo com o método. Na análise dos dados aplicaram-se as etapas da Teoria Fundamentada em Dados que prevê a codificação inicial, focalizada, axial e teórica. Os significados, pressupostos, ações e resultantes identificados a partir das experiências e vivências das participantes no cuidado aos pacientes e seus familiares foram descritas nas categorias Situando a espiritualidade no seu viver e as subcategorias “Reconhecendo a espiritualidade como uma necessidade e complemento” e “Caminhando na espiritualidade”. Exercitando a espiritualidade na vida e as subcategorias “Praticando a espiritualidade ao seu modo”, “Percebendo a espiritualidade como uma opção de vida”, “Respeitando as crenças do outro”, “Encontrando a espiritualidade na maneira de agir e pensar”. Percebendo o papel da equipe de enfermagem no cuidado espiritual e as subcategorias “Advogando os direitos do paciente e em prol da profissão”, “Conversando sobre espiritualidade”, “Preparando a equipe de enfermagem”, “Cuidando no processo e morte e morrer”, “Limitando o cuidado pelas crenças pessoais, organizacionais e religiosas”. Identificando as manifestações das necessidades espirituais e as subcategorias “Identificando as formas de enfrentamento do sofrimento” e “Acontecendo: o momento de atender as necessidades”. Colocando a espiritualidade como prioridade no cuidado e as subcategorias “Acolhendo os pacientes e familiares”, “Utilizando práticas integrativas”, “Rezando com o paciente”, “Confortando por meio da espiritualidade” e “Continuando a acreditar todos os dias”. A integração destas categorias possibilitou identificar a categoria central Ressignificando o adoecimento e o desenvolvimento do modelo de cuidado espiritual. Além disso, foi desenvolvida uma versão prática do modelo. O estudo originou uma compreensão e interpretação conceitual e prática sobre o tema espiritualidade na enfermagem e foram delineadas as conexões entre a equipe de enfermagem e os pacientes e familiares no momento do cuidado espiritual. / This study was a qualitative approach, which used the theoretical symbolic interactionism and the Grounded Theory as methodological benchmarks. The purpose was to develop a spiritual model of care for patients and their relatives when confronting situations of illness. The study was conducted in a University Hospital in the south of Brazil and involved six nurses and four certified nurse practitioner, whose had one year or over of experience in the operating area and were performing their activities. In order to collect data, we used semi-structured interviews of intensive type and an expertise group, composed of four participants, with sights to validate the Model, during the period between March and May 2016. The ethical precepts were followed, and then we obtained the signatures of all participants in the Free and Informed Consent Form. The collection and analysis of data took place concomitantly in line with the method. When analyzing data, we applied the steps of the Grounded Theory, which foresees the initial, focused, axial and theoretical coding. The meanings, assumptions, actions and outcomes identified from the experiences and backgrounds of the participants in the care of patients and their relatives were described in the categories “Situating the spirituality in your daily life” and the subcategories “Recognizing the spirituality as a need and complement” and “Walking in the spirituality”. “Exercising the spirituality in life” and the subcategories “Practicing the spirituality in my own way”, “Perceiving the spirituality as a life choice”, “Respecting the beliefs of others”, Finding the spirituality in the way of acting and thinking”. “Perceiving the role of the nursing team in the spiritual care” and the subcategories “Advocating the patient’s rights and for the promotion of the profession”, “Talking about spirituality”, “Preparing the nursing team”, “Caring for in the process of death and dying”, “Limiting care through the personal, organizational and religious beliefs”. “Identifying the manifestations of the spiritual needs” and the subcategories “Identifying the ways of confronting the suffering” and “Happening: the time to meet the needs”. “Placing the spirituality as a priority in the care” and the subcategories “Welcoming the patients and relatives”, “Using integrative practices”, “Praying together with the patient”, “Comforting through the spirituality” and “Continuing to believe every day”. The integration of these categories has enabled us to identify the central category “Resignifying the illness”, as well as to develop a spiritual care model. In addition, we have developed a practical version of the model. The study gave rise to a practical and conceptual understanding and interpretation about the issue of spirituality in nursing, and then we drew up the connections between the nursing team and the patients and their relatives at the time of the spiritual care.

Bakgrund: Enligt den nya patientlagen ska patientens delaktighet i sin egen vård utökas och förstärkas ytterligare. Som en del i detta arbete så har personcentrerad vård införts i flera svenska regioner och landsting. Positiva effekter av personcentrerad vård har kunnat bevisas både hos patienter och vårdgivare. Syfte: Att beskriva vilka faktorer som kan försvåra möjligheterna för sjuksköterskor att ge personcentrerad vård. Metod: Examensarbetet genomfördes som en litteraturöversikt. Tio vetenskapliga artiklar publicerade mellan 2010-2016 ingick i studien. Artiklarna söktes i databaserna CINAHL och PubMed samt genom fritextsökning i Google Scholar. Resultat: Det visade sig finnas flera teman med tillhörande faktorer som kunde försvåra möjligheten för sjuksköterskor att ge en personcentrerad vård. Framträdande faktorer var bland andra sjuksköterskans förhållningssätt och syn på sin profession och på patienten, bristande patientdelaktighet, bristande teamarbete och kommunikation, svagt stöd från organisation och ledning, undermålig miljö och utbildning samt hög arbetsbelastning. Slutsats: Flera faktorer som kunde försvåra för sjuksköterskan att ge personcentrerad vård framkom, där vissa upplevdes som mer avgörande än andra. För att sjuksköterskor ska kunna ge patienten en vård baserad på patientdelaktighet så är det av stor betydelse att medvetenheten om dessa försvårande faktorer ökar. Genom att redan under sjuksköterskeutbildningen arbeta med ett personcentrerat förhållningssätt så ökar sannolikheten för att implementeringen av personcentrerad vård inom svensk hälso- och sjukvård skall lyckas. / Background: According to the new patient law, patients' involvement in their own care will be expanded and strengthened further. As part of this work, personcentred care has been introduced in several Swedish regions and county councils. Positive effects of person-centred care have been proven to exist for both patients and healthcare providers. Aim: To describe factors that can complicate the ability for nurses to provide person-centred care. Methods: The thesis project was conducted as a literature review. Ten scientific articles published between 2010-2016 were included in the study. The articles were searched in the CINAHL and PubMed databases, as well as through Google Scholar free text search. Results: There were several themes with associated factors that could complicate the possibility for nurses to provide a person-centred care. Prominent factors include the attitude of the nurse and his or her view of the profession and the patient, lack of patient participation, lack of teamwork and communication, weak support from organization and management, poor environment and education, and high workload. Conclusion: Several factors that could make it difficult for the nurse to provide person-centred care were discovered, some of which were perceived to be more crucial than others. In order for nurses to be able to provide care based on patient participation, it is very important that awareness of these aggravating factors is increased. By working with a person-centred approach already during nursing education, the likelihood of successful implementation of person-centred care in Swedish healthcare increases

Bakgrund: 15–50% av kvinnorna över hela världen har upplevt någon typ av våld. Våld förekommer i olika former och påverkar kvinnan fysiskt och psykiskt. Sjuksköterskans skyldighet är att identifiera våld samt bidra med stöd men det förekommer fortfarande svagheter när det gäller att identifiera våld. Syfte: Att beskriva sjuksköterskors upplevelser av att vårda våldsutsatta kvinnor. Metod: En allmän litteraturöversikt grundad på 10 vetenskapliga artiklar med kvalitativ ansats utifrån en tematisk analys genomfördes. Resultat: Resultatet presenterar hur sjuksköterskor upplever vårdandet av våldsutsatta kvinnor. Resultatet har sammanställts i tre teman: hög arbetsbelastning, behov av utbildning, negativa och positiva upplevelser av mötet med våldsutsatta kvinnor; och i fyra kategorier. Att vårda våldsutsatta kvinnor väcker olika känslor. Olika faktorer som försvårar identifiering av våld är tidsbrist samt okunskap. Slutsatser: Sjuksköterskor har en viktig roll för att kunna uppmärksamma att kvinnor utsätts för våld och erbjuda stöd. För att sjuksköterskor ska kunna identifiera våld samt bidra till adekvat stöd krävs det att arbetsbelastning avlastas samt att kunskap och emotionellt stöd ökar. Implikationer: Författarna föreslår vidare forskning kring vilken utbildning som är lämplig vid omhändertagande av våldsutsatta kvinnor samt hanteringsstrategier för sjuksköterskans negativa känslor. / Background: Around the world, 15–50% of women have experienced some type of violence. Violence occurs in various forms and affects women physically and mentally. The duty of the nurse is to identify violence and offer adequate measures, but there are still weaknesses when it comes to identifying violence. Aim: to describe nurses' experiences of caring for abused women. Method: A literature review based on a thematic analysis of 10 scientific articles with a qualitative approach was conducted. Results: The results present how nurses experience the care of abused women and have been compiled in three themes: high workload, need for education, negative and positive experiences of meeting abused women; and into four categories. Caring for abused women arouses different emotions. Various factors that make it difficult to identify violence are lack of time and knowledge. Conclusions: Nurses have an important role to play in being able to draw attention to the fact that women are exposed to violence and offer support. In order for nurses to be able to identify violence and contribute to adequate support, it is necessary that the workload is relieved and that knowledge and emotional support increase. Implications: The authors further suggest research on what education is appropriate in the care of abused women and management strategies for nurse's negative feelings.

Bakgrund  Begreppet placebo har tidigare associerats som en overksam behandling utan terapeutisk effekt som i stor utsträckning omtalats som ett oetiskt tillvägagångssätt. Begreppet har dock i samtida forskning erkänts som en kraftfull mekanism: Placebo handlar inte om vad som tillförs patienten, utan om hur det tillförs. Denna insikt ger plats åt länken mellan omvårdnad och placeboeffekt samt idén om hur omvårdnad kan anpassas för att till fullo dra nytta av den fysiologiska mekanismen. Vid sidan om detta framhåller forskning att denna länk ännu inte gjort inträde i klinisk praxis.  Syfte  Syftet var att belysa hur åtgärder inom omvårdnad kan anpassas för att påverka placeboeffekt.  Metod  För att möta syftet utformades en icke-systematisk litteraturöversikt med induktiv ansats och integrerad analys.  Resultat  Resultatet presenteras i fem kategorier vilka i olika grad besvarar hur omvårdnad kan anpassas för att både optimera och modulera placeboeffekt i kliniska miljöer: icke-verbal kommunikation, verbal kommunikation, framhållning av patientens autonomi, anpassning av omvårdnadens estetik samt uppmuntran till somatiskt fokus.  Slutsats  Litteraturöversiktens resultat pekar på sjuksköterskans möjligheter att förstärka placeboeffekt och minska noceboeffekt, samt genom dessa förbättra individanpassad omvårdnad, öka patientens välbefinnande och optimera behandlingsresultat. Med detta ges ökad förståelse för omvårdnadens centrala roll kring placeboeffekt, placeboeffektens värde i omvårdnadskontext samt det för vårdkedjan viktiga sammanlänkandet. / Background  The term placebo has earlier been regarded as an ineffective treatment without therapeutic effect and widely referred to as an unethical method. However, the concept has through today’s research been recognized as a powerful mechanism: Placebo is not about what is administrated to the patient, but rather how it is added. This insight provides space for the link between nursing care and placebo effect, as well as the idea of how nursing care can be adapted to take full advantage of the physiological mechanism. In addition to this, research emphasizes that this link has not yet been accessed in clinical practice. Aim  The aim was to illustrate how placebo effect can be achieved by adaptations of interventions in nursing care.  Method  To meet the purpose a non-systematic literature review was designed with an inductive approach and an integrated analysis.  Results  The results are presented in five categories of which to varying degrees answer how nursing care can be adapted to optimize as well as modulate the placebo effect in clinical environments: non-verbal communication, verbal communication, emphasis on the patient's autonomy, adaptation of the aesthetics of nursing and encouragement of somatic focus.  Conclusions  The results of the literature review point to the nurse’s opportunities to strengthen the placebo effect, reduce the nocebo effect and through these improve individualized nursing care, increase the patient’s well-being and optimize treatment outcome. This provides an increased understanding of nursing care as a central part in placebo effect, the placebo effect’s value within the context of nursing care, and their significant interconnection within caregiving.