<p><strong>Syfte:</strong> Syftet med litteraturstudien var att beskriva brännskadade personers upplevelser av livet efter en brännskada. <strong>Bakgrund:</strong> En brännskada är ett trauma för både kropp och själ och ett stort lidande för den drabbade. Fysiska förändringar och psykologisk kris gör vägen tillbaka svår. Genom medicinskt kunnande och genom att vara ett medmänskligt stöd har sjuksköterskan en viktig roll under både den fysiska och psykiska läkningsprocessen. <strong>Metod: </strong>Studien är en allmän litteraturstudie baserad på fem kvalitativa vetenskapliga artiklar samt en självbiografi, publicerade mellan år 2003-2008. Analysen innebar att meningsbärande enheter togs ut och sammanfördes till tre huvudkategorier med tillhörande underkategorier. <strong>Resultat:</strong> De brännskadade upplevde att livet efter brännskadan innebar stort lidande och gjorde att de inte längre kunde vara självständiga. De upplevde bristande tillit till sin egen kropp vilket ledde till ett försämrat självförtroende. För att kunna gå vidare i livet var det viktigt att finna vägar för att acceptera och hantera det som hänt. Efter hand kunde livet ses positivt och värderas högre. Flera olika faktorer hade stor betydelse för att de skulle kunna känna trygghet i sitt förändrade liv. <strong>Slutsats: </strong>För att sjuksköterskan ska finnas där som stöd för den brännskadade behövs djupare kunskap inom området, vilket gör att ytterligare forskning är betydelsefull. Kunskapen skulle kunna spridas vidare genom att brännskadade föreläser om sina upplevelser och att de som är insatta i ämnet handleder personal inom hälso- och sjukvård utifrån casemetodik.</p> / <p><strong>Aim:</strong> The purpose was to describe how people with burn injuries experience their life after a burn injury. <strong>Background:</strong> A burn injury is a trauma for both body and soul and a big suffering for the person who is affected. Physical changes and psychological crisis makes it hard to recover. By medical knowledge and through human support nurses have an important role during the physical and psychological healing process. <strong>Method:</strong> This study is a literature overview, based on five qualitative scientific articles and one biography, published between the years 2003-2008. In the analysis meaning units were identified and brought together into main categories and sub categories. <strong>Result:</strong> People with burn injuries experiences that life after the injuries meant a great deal of suffering as well as a loss of independence. They experienced lacking trust in their own body, which lead to impaired self-confidence. To be able to move on in life, they had to find ways to accept and deal with what had happened. Several different factors were of importance to make them feel safety in their changed life. <strong>Conclusions: </strong>For the nurse to be able to be there for people with burn injuries, more knowledge of the subject is needed, which makes further research important. The knowledge could spread by the burn injured holding lectures about his or hers experiences, and by the well-informed tutoring health care staff and students using case methodology.</p>

<p>Aim: The overall aim of this thesis was to deepen the understanding of nursing care for seriously ill patients on the edge of life in intensive care unit (ICU) and nursing home when questions were raised whether to withhold or withdraw curative treatment. Method: All studies were conducted in a qualitative frame of reference with interviews of nurses in two contexts in Norway; group interviews of 14 nurses in an ICU (study I, III), and individual interviews of 14 nurses in two nursing homes (study II, IV). Data were analysed with interpretative phenomenology (I, III, IV) and phenomenography (II). Findings: The nurses’ descriptions of the patients on the edge of life were interpreted as ‘being in a twilight zone’, a state between living and dying. The patients’ situation were understood to be very burdensome as they were mostly ‘voiceless’ and unable to call for, or refuse help and totally surrendered to other people’s devices. Their state was strained by extensive suffering; pains and bodily afflictions, loneliness, confusion and without control and dignity (I). Their need for nursing care was comprehensive (I, II) with an overall need for dignity (II), which included having the needs for preparedness, human relationship, comfort and safety met (II). The patients’ inabilities to express themselves clearly involved major challenges for nursing care (I - IV). Good nursing care was described as caring for the individual patient based on his/her situation and needs. The nurses experienced themselves to be of imperative importance for the patient’s living or dying (III, IV) and their interpretation of the patient’s condition was crucial (III). Their commitment and drive to help was high, they knew what good nursing care was for the patients (I - IV), and they were proud when they succeeded in their care (III, IV). An outstanding finding was the nurses’ experiences of ambiguity of both certainty and uncertainty. Being certain mostly seemed to concern nursing care related to the patient’s needs and situation (I, II), and uncertainty to what was ‘right’ to do with regards to withholding or withdrawing treatment (III, IV). They often experienced loneliness, too much responsibility, a vulnerable professional pride, and being pulled between opposite poles when they struggled to give good nursing care (I - IV), but too often they failed (II, IV). This demanding situation sometimes led to the nurses’ use of several self-protecting strategies. Whether the patients could receive good nursing care or not did not only depend on the single nurse, but was also anchored in opportunities and hindrances on a relational and an organisational level (I – IV). There were many congruities in patterns in the experiences of ICU - and nursing - home - nurses with regards to the situation and needs of patients on the edge of life, and good nursing care. Congruities were also found regarding being a nurse when caring for these patients, and nurses’ opportunities and hindrances for carrying out good nursing care. Conclusion: This thesis shows that nursing care was experienced as being of crucial importance to the patients on the edge of life, and the nurses knew very well what good nursing care was for them. However, the nurses’ opportunities to perform good nursing care depended on several preconditions and were restricted by hindrances on different levels, which have to be overcome in order to fulfil patients’ needs and nurses’ ambitions of giving good nursing care. As such, this thesis highlights a wide-ranging understanding of nursing care for these patients, which should challenge individual nurses, but also other health care workers, leaders and politicians.</p>

<p><strong>SAMMANFATTNING</strong></p><p><strong> </strong></p><p><strong>BAKGRUND </strong></p><p>Syftet med studien var att få information om anhörigas upplevelse av vården på en av fem geriatriska avdelningar i Uppsala län 2008. Studien undersökte upplevelsen av tillgäng­lighet, delaktig­het, information och bemötande. En jämförelse gjordes för att se om skill­nader fanns mel­lan den studerade avdelningen (grupp 1, n=39) och de tidigare studerade geriatriska avdelning­arna (grupp 2, n=162). <strong> </strong></p><p><strong> </strong></p><p><strong>METOD </strong></p><p>Studien är deskriptiv och jämförande med kvantitativ metod och analysen utfördes med deskriptiv statistik. Antal anhöriga som deltog var 39 av 50 tillfrågade (n=78 %). Skillna­der i svar mellan grupperna redovisas med icke parametriskt test för att på­visa om statis­tisk signifikans fanns.<strong> </strong></p><p><strong> </strong></p><p><strong>RESULTAT </strong></p><p>Resultatet visar att anhöriga var positiva gällande tillgänglighet, delaktighet och bemö­tande. Behov till förbättringar finns att göra i kontakten med läkarna och deras tillgäng­lighet. Många anhöriga visade mer negativa svar i temat information och upplevde att ingen in­formation gavs i flertalet av frågorna. Vid en jämförelse mellan grupp 1 och grupp 2 fanns en statistiskt signifikant skillnad endast i läkarkontakt men övrigt fanns ingen skillnad. <strong> </strong></p><p><strong> </strong></p><p><strong>SLUTSATS</strong></p><p>Anhöriga i studien var övervägande positiva till den geriatriska vården av deras närstå­ende. Resultatet av studien kan ligga till grund för förbättringsarbete och en kvalitetssäk­ring av vården och resultatet här visar att informationsområdet och läkarnas tillgänglighet kan för­bättras.</p><p> </p><p><strong>NYCKELORD</strong></p><p>Geriatric care, elderly people, relatives, nursing care, Sweden</p>

<p><strong>Syfte:</strong> Att undersöka hur kvinnor med diabetes typ-1 upplever informationen före och i samband med graviditet samt omvårdnaden i samband med graviditet. <strong>Metod:</strong> Semistrukturerade intervjuer med sju kvinnor genomfördes och innehållet analyserades med tematisk analysmetod för att få fram kategorier och subkategorier. <strong>Resultat:</strong> Majoriteten av kvinnorna fick information gällande graviditet i samband med behandlingen av sin diabetessjukdom av hälsovården innan de blev gravida. Många av kvinnorna upplevde att fokus under graviditeten låg på blodsockerkontrollerna och att barnmorskorna på specialistmödravården fokuserade på diabetessjukdomen och glömde mödravården. Informationen på specialistmödravården upplevdes som bristande eller saknades helt och kvinnorna valde att söka information själva. Omvårdnaden och mottagandet var bra på specialistmödravården fastän det framkom att väntetiderna ibland var långa och att personalen var ostrukturerad. <strong>Slutsats:</strong> De flesta kvinnorna upplever att informationen på specialistmödravården är bristande eller att den kommer för sent, medan de upplever att omvårdnaden i de flesta fall är bra. Vi anser att det finns utrymme för förbättringar genom att exempelvis utforma en broschyr med information gällande graviditet i samband med diabetes typ-1. Vi tycker att det är viktigt att vårdpersonalen förklarar för kvinnorna hur de kan minimera riskerna och poängtera att många kvinnor med diabetes typ-1 idag får friska barn.</p> / <p><strong>Aim:</strong> To investigate how women with diabetes type-1 experienced information before and during pregnancy and nursing care during pregnancy. <strong>Method:</strong> Semi-structured interviews with seven women were carried out and the content was analyzed with a thematic analysis to generate categories and subcategories. <strong>Result:</strong> The majority of the women received information about pregnancy associated with diabetes type-1 in health care before they became pregnant. Many women felt that the focus during pregnancy was on blood sugar control and that the focused on diabetes and forgot about maternity care. The information received was seen as inadequate or missing entirely, and the women chose to seek information themselves. The care was good although it appeared that the waiting times were long and the staff was unstructured. <strong>Conclusion:</strong> Most women feel that the information is inadequate or that it comes too late, while they experience that the care in most cases is good. We believe that there is room for improvement, for example by designing a brochure with information regarding pregnancy associated with diabetes type-1. We think it is important that health professionals explain to women how they can minimize risks and point out that many women with diabetes type-1 have healthy children.</p>

Aim: The overall aim of this thesis was to deepen the understanding of nursing care for seriously ill patients on the edge of life in intensive care unit (ICU) and nursing home when questions were raised whether to withhold or withdraw curative treatment. Method: All studies were conducted in a qualitative frame of reference with interviews of nurses in two contexts in Norway; group interviews of 14 nurses in an ICU (study I, III), and individual interviews of 14 nurses in two nursing homes (study II, IV). Data were analysed with interpretative phenomenology (I, III, IV) and phenomenography (II). Findings: The nurses’ descriptions of the patients on the edge of life were interpreted as ‘being in a twilight zone’, a state between living and dying. The patients’ situation were understood to be very burdensome as they were mostly ‘voiceless’ and unable to call for, or refuse help and totally surrendered to other people’s devices. Their state was strained by extensive suffering; pains and bodily afflictions, loneliness, confusion and without control and dignity (I). Their need for nursing care was comprehensive (I, II) with an overall need for dignity (II), which included having the needs for preparedness, human relationship, comfort and safety met (II). The patients’ inabilities to express themselves clearly involved major challenges for nursing care (I - IV). Good nursing care was described as caring for the individual patient based on his/her situation and needs. The nurses experienced themselves to be of imperative importance for the patient’s living or dying (III, IV) and their interpretation of the patient’s condition was crucial (III). Their commitment and drive to help was high, they knew what good nursing care was for the patients (I - IV), and they were proud when they succeeded in their care (III, IV). An outstanding finding was the nurses’ experiences of ambiguity of both certainty and uncertainty. Being certain mostly seemed to concern nursing care related to the patient’s needs and situation (I, II), and uncertainty to what was ‘right’ to do with regards to withholding or withdrawing treatment (III, IV). They often experienced loneliness, too much responsibility, a vulnerable professional pride, and being pulled between opposite poles when they struggled to give good nursing care (I - IV), but too often they failed (II, IV). This demanding situation sometimes led to the nurses’ use of several self-protecting strategies. Whether the patients could receive good nursing care or not did not only depend on the single nurse, but was also anchored in opportunities and hindrances on a relational and an organisational level (I – IV). There were many congruities in patterns in the experiences of ICU - and nursing - home - nurses with regards to the situation and needs of patients on the edge of life, and good nursing care. Congruities were also found regarding being a nurse when caring for these patients, and nurses’ opportunities and hindrances for carrying out good nursing care. Conclusion: This thesis shows that nursing care was experienced as being of crucial importance to the patients on the edge of life, and the nurses knew very well what good nursing care was for them. However, the nurses’ opportunities to perform good nursing care depended on several preconditions and were restricted by hindrances on different levels, which have to be overcome in order to fulfil patients’ needs and nurses’ ambitions of giving good nursing care. As such, this thesis highlights a wide-ranging understanding of nursing care for these patients, which should challenge individual nurses, but also other health care workers, leaders and politicians.

Individer som blivit brännskadade upplever både fysiska och psykiska hinder. En acceptans av den nya kroppen kan ta lång tid. Under rehabiliteringsprocessen på sjukhuset arbetar det multiprofessionella teamet med denna patientgrupp för att de ska kunna klara av vardagen. Sjuksköterskan bör ha god kunskap av att vårda brännskadade patienter. Syftet med litteraturstudien var att belysa hur individen upplever sin livssituation efter en brännskada för att sjuksköterskan ska få en ökad kunskap och därigenom kunna ge en god omvårdnad. Sjutton vetenskapliga artiklar bearbetades för att sedan sammanställas till ett resultat med olika teman. Resultatet visade fem teman; Upplevelsen av stöd, upplevelsen av att hantera brännskadan, upplevelsen av smärta och klåda, upplevelse av livskvaliteten efter brännskadan samt upplevelsen av vården. Brännskadade individer behöver stöd från om-vårdnadspersonal och närstående. Copingstrategier användes för att utstå både fysisk och psykisk smärta. Livskvaliteten kunde både försämras och förbättras efter en brännskada. Att vårda patienter med brännskador kräver goda kunskaper inom omvårdnad då den omfattar många delar. Mer forskning inom området behövs för att sprida kunskap. Även en stödgrupp för brännskadade patienter borde etableras för att kontakt mellan brännskadade individer ska upprättas. / Individuals who have endured burn injuries experience both physical and psychological barriers. Coming to terms with lasting effects of burn injuries on the body can take a long time. The rehabilitation process in the hospital is at a multi-professional level, drawing across a large cross section of specialist skills to enable patients to cope with everyday life. Nurses need to have a good knowledge base to care for burn injured patients. The purpose of this study was to highlight how individuals feel about their life after a burn injury, to help nurses get a better understanding of the subject and therefore provide good health care. Seventeen scientific articles were analysed and then complied into a conclusion with different themes. These themes were; the experience of support, the experience to cope with burns, the experience of pain and pruritus, experience of the quality of life and the experience of the health care. Burn injured patients need support from the nursing staff and relatives. Coping strategies were used to endure both physical and mental pain. The quality of life could be either worse or better after a burn injury. Caring for patients with burns requires a high level of knowledge in nursing, as it affects the many stages of recovery. More research in this area is needed to increase know-ledge. A support group for burn patients should also be established in order to support contacts between burn injured individuals.

Syfte: Att undersöka hur kvinnor med diabetes typ-1 upplever informationen före och i samband med graviditet samt omvårdnaden i samband med graviditet. Metod: Semistrukturerade intervjuer med sju kvinnor genomfördes och innehållet analyserades med tematisk analysmetod för att få fram kategorier och subkategorier. Resultat: Majoriteten av kvinnorna fick information gällande graviditet i samband med behandlingen av sin diabetessjukdom av hälsovården innan de blev gravida. Många av kvinnorna upplevde att fokus under graviditeten låg på blodsockerkontrollerna och att barnmorskorna på specialistmödravården fokuserade på diabetessjukdomen och glömde mödravården. Informationen på specialistmödravården upplevdes som bristande eller saknades helt och kvinnorna valde att söka information själva. Omvårdnaden och mottagandet var bra på specialistmödravården fastän det framkom att väntetiderna ibland var långa och att personalen var ostrukturerad. Slutsats: De flesta kvinnorna upplever att informationen på specialistmödravården är bristande eller att den kommer för sent, medan de upplever att omvårdnaden i de flesta fall är bra. Vi anser att det finns utrymme för förbättringar genom att exempelvis utforma en broschyr med information gällande graviditet i samband med diabetes typ-1. Vi tycker att det är viktigt att vårdpersonalen förklarar för kvinnorna hur de kan minimera riskerna och poängtera att många kvinnor med diabetes typ-1 idag får friska barn. / Aim: To investigate how women with diabetes type-1 experienced information before and during pregnancy and nursing care during pregnancy. Method: Semi-structured interviews with seven women were carried out and the content was analyzed with a thematic analysis to generate categories and subcategories. Result: The majority of the women received information about pregnancy associated with diabetes type-1 in health care before they became pregnant. Many women felt that the focus during pregnancy was on blood sugar control and that the focused on diabetes and forgot about maternity care. The information received was seen as inadequate or missing entirely, and the women chose to seek information themselves. The care was good although it appeared that the waiting times were long and the staff was unstructured. Conclusion: Most women feel that the information is inadequate or that it comes too late, while they experience that the care in most cases is good. We believe that there is room for improvement, for example by designing a brochure with information regarding pregnancy associated with diabetes type-1. We think it is important that health professionals explain to women how they can minimize risks and point out that many women with diabetes type-1 have healthy children.

Studier har visat att sjuksköterskors arbetsmiljö kan påverka dem i deras omvårdnadsarbete. Studien ämnade intervjua sjuksköterskor om hur de upplevde att deras arbetsmiljö påverkade deras omvårdnadsarbete. Intervjuer genomfördes med sju sjuksköterskor på ett sjukhus i Västsverige. Intervjuerna analyserades och manifesta meningsenheter, kopplade till studiens syfte, identifierades och kondenserades. Resultatet visade att det finns flera faktorer i sjuksköterskornas arbetsmiljö som de upplever påverkar dem i deras omvårdnadsarbete. Sjuksköterskorna upplevde att en god stämning i personalgruppen kunde hjälpa dem i omvårdnadsarbetet. Samtidigt kunde arbetsstress och tidsbrist, till stor del på grund av tidskrävande administrativa uppgifter, ha en negativ påverkan på omvårdnadsarbetet. Slutsatsen av studien är att sjuksköterskor upplever att deras arbetsmiljö kan ha en positiv och negativ påverkan på omvårdnadsarbetet. Framtida forskning kring sjuksköterskors arbetsmiljö behövs för att bättre kunna främja omvårdnadsarbetet. / Studies have shown that nurses work environment can affect them in their nursing care. This study aimed to interview nurses about their perception of how their work environment affects nursing care. Interviews were conducted with seven registered nurses at a hospital in western Sweden. The interviews were analyzed and manifest content linked to the aim of the study was identified and then condensed. The results showed that there are many different aspects in nurses work environment that they feel affect them in their nursing care. Nurses experienced that a good social climate could help them in their nursing care. At the same time work related stress and lack of time for patients, mostly due to time consuming administrative work, had a negative impact on nursing care. The conclusion of this study is that nurses experience that their work environment can have both a positive and a negative effect on nursing care. Future research on nurses work environment is needed to better serve the needs of nursing care.

SAMMANFATTNING BAKGRUND Syftet med studien var att få information om anhörigas upplevelse av vården på en av fem geriatriska avdelningar i Uppsala län 2008. Studien undersökte upplevelsen av tillgäng­lighet, delaktig­het, information och bemötande. En jämförelse gjordes för att se om skill­nader fanns mel­lan den studerade avdelningen (grupp 1, n=39) och de tidigare studerade geriatriska avdelning­arna (grupp 2, n=162). METOD Studien är deskriptiv och jämförande med kvantitativ metod och analysen utfördes med deskriptiv statistik. Antal anhöriga som deltog var 39 av 50 tillfrågade (n=78 %). Skillna­der i svar mellan grupperna redovisas med icke parametriskt test för att på­visa om statis­tisk signifikans fanns. RESULTAT Resultatet visar att anhöriga var positiva gällande tillgänglighet, delaktighet och bemö­tande. Behov till förbättringar finns att göra i kontakten med läkarna och deras tillgäng­lighet. Många anhöriga visade mer negativa svar i temat information och upplevde att ingen in­formation gavs i flertalet av frågorna. Vid en jämförelse mellan grupp 1 och grupp 2 fanns en statistiskt signifikant skillnad endast i läkarkontakt men övrigt fanns ingen skillnad. SLUTSATS Anhöriga i studien var övervägande positiva till den geriatriska vården av deras närstå­ende. Resultatet av studien kan ligga till grund för förbättringsarbete och en kvalitetssäk­ring av vården och resultatet här visar att informationsområdet och läkarnas tillgänglighet kan för­bättras.   NYCKELORD Geriatric care, elderly people, relatives, nursing care, Sweden

Syftet med litteratur studien var att beskriva vilka studier som har gjorts med fokus på ”grön omsorg” /utemiljö i vården av personer med demens, samt att beskriva personalens upplevelse av dessa omvårdnadsåtgärder och eventuella effekter på de boende. Litteratursökningar gjordes i databaserna Medline och Chinal, och resulterade i nio inkluderade studier. Resultatet visade att flertalet av studierna hade som syfte att studera utemiljö och boendes välbefinnande och beteende. Sex studier hade en icke-experimentell design, två studier hade en kvasiexperimentell design och en studie var uppdelad i två delar varav den ena delen hade en icke-experimentell design och den andra delen hade en kvasiexperimentell design. Studierna var publicerade under åren 1992-2006 och vanligast förekommande datainsamlingsmetod var observationer av funktionsförmåga/beteende hos de boende. Granskningen av artiklarna indikerade positiva förändringar, framförallt minskat aggressivt beteende och förbättrat välbefinnande vid vistelse i utemiljöer hos personer med demens. Personalen och närstående var i stort positivt inställda till dessa utemiljöer i omvårdnaden av personer med demens. / The aim of the review was to describe studies that have been done with focus on “green care”/exterior environment in the care of people with dementia. Another aim was to describe the staff member’s experience of these arrangements and contingent effects, on the patients. Literature search was made in Medline and Chinal databases, and resulted in nine included studies. The results indicated that a majority of these studies had outdoor environment and effects on the residents’ well being and behavior as a study purpose. Six studies had a non-experimental design, two studies had a quasi-experimental design and one study was divided into two parts of which the first part had a non-experimental design and the second part had a quasi-experimental design. The studies were published between 1992- 2006 and the most common method of collecting data was observations of functionality/behaviour of the residents. The review of the studies focusing on the exterior environment indicated positive changes in subjects with dementia. In particular a decrease of aggressive behaviour and improved well being was seen. The staff and the subjects’ relatives were all in all positive to the outdoor environments in the care of subjects with dementia.