Please read the abstract in the section 00front of this document / Thesis (DPhil)--University of Pretoria, 2009. / Nursing Science / unrestricted

Praktisering av brukermedvirkning krever at sykepleierne ser på brukerne som likeverdige partnere. Det bryter med det tradisjonelle sykepleier–pasientforholdet og krever andre arbeidsmetoder og holdninger. For å kunne få til en slik endring forutsetter det at sykepleierne har nødvendig kunnskap og forståelse for brukermedvirkning og den bakenforliggende ideologien. Hensikt: Hensikten med studiet var å studere sykepleiernes teoretiske forståelse av begrepet brukermedvirkning og kartlegge hvordan sykepleierne selv opplever at de praktiserte brukermedvirkning i kommunens omsorgstjeneste. Metode: Det har blitt gjennomført en kvalitativ studie med halvstrukturerte intervjuer. Analysemetode var meningsfortettning og meningskategorisering etter beskrivelse av Kvale. Studien har 20 respondentern fra sykehjem og hjemmetjenesten i en stor norsk kommune. Resultater: Sykepleiernes kunnskap om brukermedvirkning var i stor grad situasjonsbestemt. Den ble beskrevet ut fra pasientene de selv arbeider med, situasjonene og konteksten. Det ble knyttet usikkerhet til den teoretiske forståelse av begrepet. Brukermedvirkning blir i hovedsak beskrevet som samråd og må forstås som symbolsk deltagelse der pasientenes deltar og gir uttrykker behov eller gir råd uten at de har reell innflytelse eller myndighet. Langt færre beskrev brukermedvirkning som brukerinnflytelse i form av partnerskap der pasienten gis anledning til å ta avgjørelse og oppleve kontroll.I hvilken grad brukermedvirkning praktiseres avhenger av avveininger i tjenesteutforming, institusjonelle forhold og strukturelle rammer. Sykepleiere opplevde ved håndtering av meningsforskjeller mellom pasient og pårørende en lojalitet overfor pasienten samtidig som de viser forståelse overfor pårørende. Konklusjon: Sykepleiernes forståelse av brukermedvirkning handler i stor grad om symbolsk deltagelse fordi de gis mulighet til å uttrykke ønsker men ikke fatte endelig avgjørelse. Implementering av brukermedvirkning på systemnivå og en kombinasjonen av teoretisk kunnskap og refleksjon over praksis, vil kunne styrke bevisstheten og vektleggingen av brukermedvirkning. / The practice of user participation requires nurses to regard users as equal partners. It breaks with the traditional nurse-patient relationship and demands different working methods and attitudes. Achieving such a change requires nurses to have the necessary knowledge and understanding of user participation and the ideology behind it. Objective: This study aimed to investigate nurses’ understanding and practice of user participation in the municipal care service. Method: We implemented a qualitative study by conducting semi-structured interviews with 20 respondents from nursing homes and home care services in a major Norwegian municipality.Analysis involved consolidating and categorizing the subjects’ intent, as described by Kvale. Results: The nurses’ knowledge of user participation was situational (i.e., they based their descriptions on current patients, situations, and context). Their theoretical understanding of the concept was uncertain. Most described user participation as a consultation that must be understood as symbolic participation, where the patients express their needs or give advice without having any real influence or authority. Far fewer nurses described user participation as user influence in the form of a partnership, where patients are given the opportunity to make decisions and experience control. The extent to which nurses practice user participation depends on trade-offs among services, institutional situations, and structural frameworks. When faced with differing opinions between patients and their relatives, nurses experienced loyalty toward their patients and simultaneously showed empathy for the relatives. Conclusion: Nurses’ understanding of user participation largely deals with symbolic participation because it enables patients to express desires without making any final decisions. Implementing user participation at the system level and combining theoretical knowledge and reflection in practice would strengthen awareness and focus attention on user participation / <p>ISBN 978-91-85721-73-3</p>

Summaries in Afrikaans and English / Die begin van die nuwe millennium word gekenmerk deur radikale vooruitgang op tegnologiese gebied, paradigmatiese verskuiwings in natuur- en geesteswetenskappe, toenemende onsekerheid oor wat die ware aard van die mens is en hoe die een mens die ander verantwoordbaar kan help met die oplossing van probleme en herstel van menswaardigheid deur middel van opvoedkundige sielkundige ondersteuning. Navorsing is ondemeem om 'n beeld te verkry van wat 'n verantwoordbare opvoedkundige sielkundige praktyk met besondere verwysing na pedoterapie, kan wees. 'n Literatuurstudie is gedoen aangaande grondeise van 'n verantwoordbare opvoedkundige sielkundige praktyk in historieskomtemporere konteks. 'n Verdere literatuurstudie is gedoen aangaande 'n verantwoordelike en verantwoordbare pedoterapeutiese praktyk in opvoedings- en medemenslikheidsperspektief. 'n Teoretiese fundering van pedoterapie is gedoen, waarin daar, onder andere, klem geplaas is op 'n ontleding van die begrip en idee pedoterapie, pedoterapeutiese verhoudinge, diagnostisering, vorme van pedoterapie en die aard enrol van 'n mensbeeld in die opvoedkundige sielkundige praktyk. 'n Soektog na kategoriee waarmee 'n verantwoordbare Sielkundige Opvoedkundige wetenskap en opvoedkundige sielkundige praktyk beskryf kan word, is ondemeem. Daarna is kriteria vir die evaluering van pedoterapeutiese arbeid geformuleer. Die oorsprong vir en die waarde van 'n universele etiese kode vir terapeute is teen die agtergrond van 'n mensbeeld bespreek. Aan die hand van 'n empiriese ondersoek is daar bepaal wat die stand van opvoedkundige sielkundige teorie en praktyk teenswoordig sou wees. Hierdie empiriese ondersoek is met idiografiese onderhoude uitgevoer, waama idiogramme saamgestel is. Met die empiriese ondersoek is daar gepoog om 'n beeld te verkry van hoe vertroud hedendaagse praktisyns met teoretiese grondslae en die waarde van 'n ontologiese mensbeeld, die waarde van evalueringskriteria en die stand van die Sielkundige Opvoedkunde se toepassingsmoontlikhede vir die pedoterapeutiese praktyk is of nie is nie. Deelnemende opvoedkundige sielkundige praktisyns se praktyksbenadering in etiese en praktiese konteks is verkry asook bulle oordele van, onder meer, heersende voorskrifte en voorstelle ter bevordering van die opvoedkundige sielkundige praktyk. 'n Aantal aanbevelings is gemaak op grond van die bevindinge vanuit die totale studie. 'n Aanloop tot die daarstelling van 'n etiese kode vir opvoedkundige sielkundiges is gemaak. / The beginning of the new millennium is characterized by radical technological progress, paradigm shifts in natural and human sciences, increasing uncertainty about the real nature of the human being and how one person can assist another in an accountable way with solving problems in order to restore human dignity through educational psychological assistance. Research is carried out to determine what an accountable educational psychological practice, with special reference to pedotherapy, should entail. A literature study regarding basic requirements of an accountable educational psychological practice in historical and contemporary perspective is included. A further literature study is executed concerning an accountable pedotherapeutic practice. A theoretical grounding of pedotherapy is included in the literature study and specific attention is given to an analysis of the concepts and ideas of pedotherapy. pedotherapeutic relationships, the diagnostic approach and forms of pedotherapy. The nature and role of a view of human kind in educational psychological practice is also discussed. Categories describing an accountable science of Psychology of Education and its practice are presented. Subsequent criteria for the evaluation of pedotherapeutic endeavour are formulated. Origins for and the value of a universal code of ethics for pedotherapists are discussed against the background of a view of human kind. By means of an empirical investigation it is determined what the current status of Psychology of Education in theory and practice is. This investigation is conducted by means of idiographic interviews and afterwards idiogrammes are compiled to determine to what extent practitioners are conversant with theoretical foundations and an ontological view of human kind, the value of evaluation criteria and the possibilities presented by the insights of Psychology of Education and how practitioners approach their practice in ethical stance. Also the views of practitioners on current prescriptions and their suggestions for improving educational psychological practice are obtained. A number of recommendations is presented in the light of findings from the entire study. A trial run for the formulation of an ethical code for educational psychologists is presented. / Psychology of Education / D. Ed. (Sielkundige Opvoedkunde)

The overall aim was to investigate the quality of palliative care from the patient perspective, to adapt and psychometrically evaluate the Quality from Patients’ Perspective instrument specific to palliative care (QPP-PC) and investigate the relationship between the combination of person- and organization-related conditions and patients’ perceptions of care quality. Methods: In the systematic literature review (I), 23 studies from 6 databases and reference lists in 2014 were synthesized by integrative thematic analysis. The quantitative studies (II–IV) had cross-sectional designs including 191 patients (73% RR) from hospice inpatient care, hospice day care, palliative units in nursing homes and home care in 2013–2014. A modified version of QPP was used. Additionally, person- and organization-related conditions were assessed. Psychometric evaluation, descriptive and inferential statistics were used. Main findings: Patients’ preferences for palliative care included living a meaningful life and responsive healthcare personnel, care environment and organization of care (I). The QPP-PC was developed, comprising 12 factors (49 items), 3 single items and 4 dimensions: medical–technical competence, physical–technical conditions, identity–oriented approach, and socio-cultural atmosphere (II). QPP-PC measured patients’ perceived reality (PR) and subjective importance (SI) of care quality. PR differed across settings, but SI did not (III). All settings exhibited areas of strength and for improvement (II, III). Person-related conditions seemed to be related to SI, and person- and organization-related conditions to PR, explaining 18–30 and 22-29% respectively of the variance (IV). Conclusions: The patient perspective of care quality (SI and PR) should be integrated into daily care and improvement initiatives in palliative care. The QPP-PC can measure patients’ perceptions of care quality. Registered nurses and other healthcare personnel need awareness of person- and organization-related conditions to provide high-quality person-centred care. / Knowledge about patients’ perceptions of palliative care is limited and valid instruments are needed. The aim of this thesis was to investigate quality of palliative care from the patient perspective, adapt and evaluate an instrument to measure patients’ perceptions of quality in palliative care (QPP-PC), and investigate the relationship between the combination of person- and organization-related conditions and patients’ perceptions of care quality. A systematic literature review and quantitative methods were used. Patients’ preferences in palliative care included help living a meaningful life and responsive personnel, care environment and organization of care. The QPP-PC was developed and identified patients’ perceptions of areas of strength and for improvement in hospice inpatient and day care, palliative units in nursing homes and home care settings. Perceptions of care quality seemed to be related to person- and organization-related conditions, and differed across settings, although subjective importance did not. The patient perspective of care quality should be integrated into daily care and quality work, and QPP-PC can be used in such work. Registered nurses and other healthcare personnel need awareness of person- and organization-related conditions to provide high-quality person-centred palliative care. / Den overordnede hensikten var å undersøke kvalitet i palliativ behandling og omsorg fra pasientens perspektiv, å utvikle og psykometrisk evaluere spørreskjemaet Kvalitet ut fra Pasientens Perspektiv (KUPP) for palliativ omsorg (KUPP-PO), samt å undersøke sammenhengen mellom person- og organisasjonsrelaterte forhold og pasientenes erfaringer av kvalitet. Metode. I den systematiske oversiktsartikkelen (I) ble 23 studier fra seks databaser og referanselister syntetisert i 2014 med integrativ tematisk analyse. De kvantitative studiene (II-IV) hadde et tverrsnittsdesign som inkluderte 191 pasienter (svarprosent: 73) fra hospice-døgnavdeling, hospice-dagavdeling, lindrende enheter i sykehjem og hjemmetjeneste i 2013 til 2014. En modifisert versjon av KUPP ble brukt. I tillegg ble person- og organisasjonsorienterte forhold kartlagt. Deskriptiv og  inferensiell statistikk, samt psykometrisk evaluering ble anvendt. Hovedfunn. Pasientene ønsket at palliativ behandling og omsorg skulle omfatte hjelp til å leve et meningsfullt liv og at helsepersonell, omsorgsmiljø og organisering av omsorgen var lydhør for og handlet eller var tilrettelagt i samsvar med deres preferanser (I). KUPP-PO ble utviklet og omfattet 12 faktorer (49 spørsmål), 3 enkeltstående spørsmål og fire dimensjoner; medisinsk-teknisk kompetanse, fysisk-tekniske forhold, identitetsorientert tilnærmingsmåte og sosiokulturell atmosfære (II). KUPP-PO målte pasientenes erfaringer og subjektiv betydning av kvalitet. Pasientens erfaringer av kvaliteten med palliativ behandling og omsorg varierte utfra kontekst, men subjektiv betydning varierte ikke. Alle omsorgskontekstene viste styrker og forbedringsområder (II, III). Personrelaterte forhold så ut til å være forbundet med subjektiv betydning mens person- og organisasjonsorienterte forhold så ut til å være forbundet med erfaring med behandling og omsorg, og forklarte respektivt 18–30/22-29% av variansen (IV). Konklusjon: Kvalitet fra pasientens perspektiv (subjektiv betydning og erfaring) bør integreres i daglig behandling og omsorg og i forbedringstiltak i palliativ omsorg. KUPP-PO kan måle pasientenes erfaringer i kvalitetsutviklingsarbeid. Sykepleiere og annet helsepersonell trenger å være bevisst person- og organisasjonsrelaterte forhold for å utføre personsentrert behandling og omsorg av høy kvalitet.

Summaries in Afrikaans and English / Die begin van die nuwe millennium word gekenmerk deur radikale vooruitgang op tegnologiese gebied, paradigmatiese verskuiwings in natuur- en geesteswetenskappe, toenemende onsekerheid oor wat die ware aard van die mens is en hoe die een mens die ander verantwoordbaar kan help met die oplossing van probleme en herstel van menswaardigheid deur middel van opvoedkundige sielkundige ondersteuning. Navorsing is ondemeem om 'n beeld te verkry van wat 'n verantwoordbare opvoedkundige sielkundige praktyk met besondere verwysing na pedoterapie, kan wees. 'n Literatuurstudie is gedoen aangaande grondeise van 'n verantwoordbare opvoedkundige sielkundige praktyk in historieskomtemporere konteks. 'n Verdere literatuurstudie is gedoen aangaande 'n verantwoordelike en verantwoordbare pedoterapeutiese praktyk in opvoedings- en medemenslikheidsperspektief. 'n Teoretiese fundering van pedoterapie is gedoen, waarin daar, onder andere, klem geplaas is op 'n ontleding van die begrip en idee pedoterapie, pedoterapeutiese verhoudinge, diagnostisering, vorme van pedoterapie en die aard enrol van 'n mensbeeld in die opvoedkundige sielkundige praktyk. 'n Soektog na kategoriee waarmee 'n verantwoordbare Sielkundige Opvoedkundige wetenskap en opvoedkundige sielkundige praktyk beskryf kan word, is ondemeem. Daarna is kriteria vir die evaluering van pedoterapeutiese arbeid geformuleer. Die oorsprong vir en die waarde van 'n universele etiese kode vir terapeute is teen die agtergrond van 'n mensbeeld bespreek. Aan die hand van 'n empiriese ondersoek is daar bepaal wat die stand van opvoedkundige sielkundige teorie en praktyk teenswoordig sou wees. Hierdie empiriese ondersoek is met idiografiese onderhoude uitgevoer, waama idiogramme saamgestel is. Met die empiriese ondersoek is daar gepoog om 'n beeld te verkry van hoe vertroud hedendaagse praktisyns met teoretiese grondslae en die waarde van 'n ontologiese mensbeeld, die waarde van evalueringskriteria en die stand van die Sielkundige Opvoedkunde se toepassingsmoontlikhede vir die pedoterapeutiese praktyk is of nie is nie. Deelnemende opvoedkundige sielkundige praktisyns se praktyksbenadering in etiese en praktiese konteks is verkry asook bulle oordele van, onder meer, heersende voorskrifte en voorstelle ter bevordering van die opvoedkundige sielkundige praktyk. 'n Aantal aanbevelings is gemaak op grond van die bevindinge vanuit die totale studie. 'n Aanloop tot die daarstelling van 'n etiese kode vir opvoedkundige sielkundiges is gemaak. / The beginning of the new millennium is characterized by radical technological progress, paradigm shifts in natural and human sciences, increasing uncertainty about the real nature of the human being and how one person can assist another in an accountable way with solving problems in order to restore human dignity through educational psychological assistance. Research is carried out to determine what an accountable educational psychological practice, with special reference to pedotherapy, should entail. A literature study regarding basic requirements of an accountable educational psychological practice in historical and contemporary perspective is included. A further literature study is executed concerning an accountable pedotherapeutic practice. A theoretical grounding of pedotherapy is included in the literature study and specific attention is given to an analysis of the concepts and ideas of pedotherapy. pedotherapeutic relationships, the diagnostic approach and forms of pedotherapy. The nature and role of a view of human kind in educational psychological practice is also discussed. Categories describing an accountable science of Psychology of Education and its practice are presented. Subsequent criteria for the evaluation of pedotherapeutic endeavour are formulated. Origins for and the value of a universal code of ethics for pedotherapists are discussed against the background of a view of human kind. By means of an empirical investigation it is determined what the current status of Psychology of Education in theory and practice is. This investigation is conducted by means of idiographic interviews and afterwards idiogrammes are compiled to determine to what extent practitioners are conversant with theoretical foundations and an ontological view of human kind, the value of evaluation criteria and the possibilities presented by the insights of Psychology of Education and how practitioners approach their practice in ethical stance. Also the views of practitioners on current prescriptions and their suggestions for improving educational psychological practice are obtained. A number of recommendations is presented in the light of findings from the entire study. A trial run for the formulation of an ethical code for educational psychologists is presented. / Psychology of Education / D. Ed. (Sielkundige Opvoedkunde)