The aim of this thesis was to modify and evaluate effects, as well as todescribe experiences of a nurse-led multidisciplinary programme of pulmonaryrehabilitation in primary health care for patients with chronicobstructive pulmonary disease (COPD) and their next of kin.Interviews were performed with 12 COPD nurses about their experiencesof patient education (I). Forty-nine patients participated in the interventiongroup and 54 in the control group in a quasi-experimentalstudy which investigated the effects of the programme on functional capacity,quality of life and exacerbation frequency during one year (II).Interviews were performed related to the experiences of 20 patients whohad participated in the six-week programme (III) and the experiences of20 next of kin to the patients that had participated (IV).The results showed that COPD nurses fluctuated between security andinsecurity in patient education and were in need of support, time, structureand collaboration to develop their patient education (I). In Study IIthere were no differences between the groups with regard to functionalcapacity and quality of life, but the number of exacerbations decreased inthe intervention group and increased in the control group (II). The patientsin study III had allowed themselves to live at their own pace followingthe programme but a constant fear was present in spite of the programme(III). Next of kin in Study IV had a life that remained overshadowedby illness but there were positive outcomes of the programme aslong as two years afterwards. The next of kin also had constant fear,however (IV).In conclusion, the six week programme brought about results in changingeveryday life. Nevertheless, all lived in the shadow of fear and uncertaintyin spite of the programme. More research is needed to address therequirements of COPD nurses, patients and next of kin.

SAMMANFATTNING Syfte: Syftet med detta arbete var att undersöka sjuksköterskors uppfattning om omvårdnadsdokumentation och dess påverkan på omvårdnadsarbetet. Metod: Kvalitativ intervjustudie med innehållsanalys enligt Lundman och Hällgren Graneheim (2008). Bekvämlighetsurval med fem sjuksköterskor från olika avdelningar på ett Universitetssjukhus i Mellansverige. Resultat: Sjuksköterskor i denna studie uppfattade att dokumentationen tar tid, det är mycket som ska dokumenteras och att kvalitén varierade. De uppfattade också att information kunde gå förlorad på grund av att många skrev på flera olika ställen. Dokumentationen upplevdes ibland som inkonsekvent eftersom sjuksköterskorna inte dokumenterade exakt lika. De belyste också att systemet var rörigt och ologiskt. Dokumentationen upplevdes ge vägledning. Det är viktigt att samarbeta mellan olika professioner samt att dokumentationen följs upp av den som tar efter. Sjuksköterskorna prioriterade det medicinska framför omvårdnaden och arbetsbördan gjorde det svårt att hinna dokumentera. Dokumentationen synliggjorde omvårdnaden samt att den kunde användas för att utvärdera vården. Slutsats: Sjuksköterskor uppfattade dokumentation som problematisk och tidsödande. Samtidigt tyckte de att det fanns vinster med dokumentation då det gav patientsäkerhet och kunde användas för att utvärdera vården. Mer arbete behövs för att nå konsensus i hur dokumentation på avdelning skall se ut. Det behövs mer forskning kring hur dokumentation påverkar omvårdnadsarbetet. / ABSTRACT Aim: The aim of this study was to investigate nurses’ perception of nursing documentation and its impact on nursing. Method: Qualitative interview study with content analysis according to Lundman and Hällgren Graneheim (2008). Convenience sample of five nurses from different wards of a University hospital in central Sweden. Result: Nurses in this study perceived the documentation as time consuming, there is a lot to be documented and that the quality varied. They also observed that the information could be lost due to many writing in several different places. The documentation is sometimes perceived as inconsistent because nurses did not document exactly alike. They also highlighted that the system was messy and illogical. Documentation was perceived as giving guidance. It is important to cooperate between different professions and that the documentation is followed up by the next person. The nurses prioritized the medical instead of nursing care and workload made ​​it difficult to find time to document. Documentation made​​ nursing care visible and it could be used to evaluate healthcare. Conclusion: Nurses perceived documentation as problematic and time consuming. They also thought there were gains of documentation when it gave patient safety and could be used to evaluate care. More work is needed to reach consensus in the documentation should be carried out. More research is required on how documentation affects nursing.

Thesis (Ph. D.)--University of Virginia, 2007. / Includes bibliographical references. Also available online through Digital Dissertations.

Diss. (sammanfattning) Umeå : Univ., 2005. / Härtill 4 uppsatser.

Diss. (sammanfattning) Växjö : Växjö universitet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2006. / Härtill 4 uppsatser.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2006. / Härtill uppsatser.

Thesis (Ph. D.)--University of Washington, 1992. / Vita. Includes bibliographical references (leaves [157]-166).

Thesis (Ph. D.)--West Virginia University, 2009. / Title from document title page. Document formatted into pages; contains xiv, 157 p. : ill. (some col.). Vita. Includes abstract. Includes bibliographical references (p. 110-121).

Thesis (M.S.)--University of Michigan, 1999. / Includes bibliographical references.