Bakgrund: Behovet av palliativ vård ökar i kapp med en åldrande befolkning och kraven på sjuksköterskornas kompetens ökar därefter. Den palliativa vården bedrivs bäst i samråd med patienter och anhöriga och anses vara mångsidig och komplex. Sjuksköterskan beskrivs ha en avgörande roll för hur den palliativa vården bedrivs och upplevs, där kommunikation är ett av de viktigaste verktygen. Samtidigt rapporteras det om sjuksköterskors bristande kunskap inom ämnet.  Syfte: Syftet med denna litteraturstudie var att undersöka sjuksköterskors upplevelse av att kommunicera med patienter och anhöriga inom palliativ vård. Metod: Studien är en litteraturöversikt med kvalitativ ansats. Datainsamlingen gjordes med hjälp av ett strukturerat sökschema i databaserna PubMed och Cinahl. Artiklarna granskades med hjälp av SBU:s granskningsmall för kvalitativ forskning. Efter kvalitetsgranskning återstod 12 artiklar som analyserades med en innehållsanalys och sedan utgjorde resultatet. Resultat: Tre huvudteman framkom efter gjord innehållsanalys, Kommunikationens deltagare, Kommunikationens kontext samt Organisatoriska faktorer.Konklusion: Kommunikation upplevs av sjuksköterskor som ett komplicerat och känslomässigt krävande område där det råder kunskapsluckor. Upplevelserna påverkas av utbildning, erfarenhet, arbetsplats och vilka som deltar i kommunikationen. Sjuksköterskor behöver erbjudas mer stöd och utbildning för att känna sig trygga i sin kommunikation och därmed kunna erbjuda den bästa möjliga omvårdnaden. / Background: The need for palliative care increases in line with an aging population and the demands on nurses' skills increase accordingly. Palliative care is best conducted in consultation with patients and relatives and is considered to be versatile and complex. The nurse's role regarding how palliative care is practiced and experienced is described as crucial, where communication is one of the most important tools. However, at the same time, nurses' lack of knowledge on the subject is reported.Aim: The purpose of this literature study was to investigate nurses' experience of communicating with patients and relatives in palliative care.Method: The study is a literature review with a qualitative approach. The data collection was done using a structured search schedule in the PubMed and Cinahl databases. The articles were reviewed using the SBU's review template for qualitative research. After quality review, 12 articles remained which were then analyzed with a content analysis and formed the result.Results: Three main themes emerged from the content analysis, The communication participants, Context and type of communication and Organizational factors.Conclusion: Communication is perceived by nurses as a complicated and emotionally demanding area where there is a gap in knowledge. The experiences are affected by education, work and personal experiences, workplace and the communications participants. Nurses need more support and training to feel confident in their communicative abilities and thus be able to offer the best possible care.

Bakgrund: En god hälsa kräver ett psykiskt så väl som fysiskt välbefinnande. De goda fysiologiska effekterna av fysisk aktivitet har länge uppmärksammats och ny forskning pekar även på flertalet psykologiska vinster. Det är dessutom allmänt känt att en stillasittande livsstil kan leda till en rad olika sjukdomar och försämrat hälsotillstånd. Patienter med psykisk ohälsa som vårdas under tvång har begränsade möjligheter till aktivitet och ett minskat självbestämmande gällande upprätthållandet av en god fysisk hälsostatus. Syfte: Syftet med denna studie är att undersöka yrkesverksamma sjuksköterskors erfarenheter av fysisk aktivitet för patienter som vårdas inom psykiatrisk tvångsvård. Metod: Designen var en empirisk intervjustudie med kvalitativ ansats. Sjuksköterskor yrkesverksamma inom psykiatrisk tvångsvård intervjuades. Analysen av insamlad data gjordes av det manifesta innehållet i intervjuerna. Resultat: Studien resulterade i sex kategorier; Den goda vårdrelationen, Hinder inom tvångsvården, Sjuksköterskans inställning, Sjuksköterskans ansvar och Individanpassad aktivitet Slutsats: Sjuksköterskor inom psykiatrisk tvångsvård hade en positiv inställning till fysisk aktivitet men hinder och svårigheter såväl inom organisationen som relaterat till patienternas sjukdomstillstånd försvårade arbetet med tillfredställandet av en god fysiskt hälsostatus. / Background: Good health requires a mental as well as physical well-being. The good physiological effects of physical activity have long been recognized and new research also points to several psychological gains. It is well known that a sedentary lifestyle can lead to a variety of diseases and conditions. Patients with mental illness who are cared for under compulsory institutional care have limited opportunities for activity and a decreased self-determination regarding the maintenance of a good physical health status. Aim: To investigate registered nurses' experiences of physical activity for patients with mental illness who are cared for under compulsory institutional care. Method: The design was an empirical interview study with a qualitative approach. Nurses working in psychiatric compulsory institutional care were interviewed. The analysis of the gathered information was made of the manifest content of the interviews. Results: The study resulted in six categories; The good nurse- patient relationship, obstacles in compulsory institutional care, nurses attitudes, nurses’ responsibility and individualized activity. Conclusion: Nurses in psychiatric compulsory institutional care had a positive attitude towards physical activity, but the obstacles and difficulties both within the organization as well as the patients' medical conditions, complicated the process of satisfying the patients physical health status.

The aim of this investigation was to elucidate and describe those patients who had discontinued their participation and/or paticipated infrequently in physiotherapy treatment based on their own activity and responsibility. The ambition was to understand the phenomenon of compliance/adherence from various perspectives in behavioural as well as social science. In study I the phenomenon compliance/adherence was studied in relation to Health Locus of Control and Health Belief variables. This study was based on a questionnaire that was answered by all patients before beginning of treatment. Questions concerning the patients´conceptions about both health locus of control and health beliefs were the focus.The definitions of compliance/adherence were completed treatment period and exercise frequency, respectively. Those patients who completed the treatment were also studied regarded exercise frequency. The results of study I showed that those who discontinued their treatment reported a higher perceived threat from their health condition (higher level of dysfunction (higher pain intensity) and a higher perceived severity of their health condition (higher level of dysfunction, worse general health) than those who completed treatment. The results also showed that those who exercised once a week or less often valued the significance of the caring situation as lower (HLC), perceived a higher threat from their health condition (higher pain intensity), a higher severity of their health condition (higher level of dysfunction, worse general health, greater distrution of impairment), more barriers to treatment (lower expectations), and had certain differences in demographic variables (younger individuals, more women) than those who exercised more often (HB). Study II investigated patients´descriptions of their reasons for discontinuing the treatment, whether those reasons varied, and if so how they varied. Sixteen patients who had discontinued their treatment were interviewed with open-ended questions. The inteviews began with a question about the background to the physiotherapy treatment. There were questions concerning carrying out the treatment as well as concerning what they thought about their impairment. The patients were also asked about their priotities in daily life, as these wre presumed to be anobstacle to the treatment over a shorter or longer period of time. The third domain concerned how they experiebced the patient/physiotherapist relationship. The interviews were anlysed qualitatively. Analysis of study II resulted in four different descriptions of reasons for treatment discontinuation. A) It was about time to end treatment and continue on alone. B) The treatment was not the most important activity to spend time on. C) An agreement with the physiothreapist to discontinue treatment due to lack of effect. D) No viewpoint as to why they discontinued the treatment. In further analysis of category D, this group appeared to experience varoius forms of powerlessness. They felt their trustworthiness was often questioned. They experienced frustration in their life situation as others made the important descisions and they themselves had little to say.They defended themselves by talking about their own conceptions of the reasons for their impairment and what should be done about them. In comparing category D with categories A, B, C it was found that those in the latter three categories experienced varying degrees of control in different situations, whereas those in category D did not experience a feeling of control. Conclusion: The concept of compliance in physiotherapy is ambiguous. The concept involves one part defining what will concern the other part. It is clear that the physiotherapist and the patient do not always agree about the aim of the treatment. Instead, we should develop the concept of concordance in encounters with the patients and abandon the reasoning of compliance. / Syftet med denna undersökning var att tydliggöra och beskriva de patienter som avbrutit sitt deltagande och/eller deltagit sällan i en behandling med sjukgymnastik baserad på egen aktivitet och eget ansvar. En ambition var att förstå fenomenet följsamhet utifrån några olika teoretiska perspektiv inom såväl beteende- som samhällsvetenskap. I Delstudie I studerades fenomenet följsamhet i relation till beteendeaspekter avseende patientuppfattningar om styrmekanismer som påverkar den egna hälsan (HLC) och patientupplevda hälsohot och hälsohotens konsekvenser (HB). Denna delstudie bygger på frågeformulär, som besvarades av samtliga patienter innan behandlingsstart. De frågor som mäter patientens uppfattningar om vad som styr den egna hälsan och frågor som mäter patientupplevda hälsohot och hälsoerfarenheter har bearbetats. Definitionerna på följsamhet var dels fullföljd träningsperiod, dels träningsfrekvens. De patienter som genomförde träningen jämfördes med de som avbröt den. De som genomförde träningen studerades dessutom avseende träningsfrekvens. Resultatet i Delstudie I visade att de som avbröt sin behandling, rapporterade större hot av sitt hälsotillstånd (högre smärtintensitet) och större konsekvenser av hälsotillståndet (sämre funktionsförmåga, sämre allmänt hälsotillstånd) än de som genomförde den. Resultatet visade dessutom att de som tränade en gång i veckan eller mer sällan hade värderat vårdsituationens betydelse lägre (HLC), upplevde större hot av sitt hälsotillstånd (högre smärtintensitet), större konsekvenser av hälsotillståndet (större funktionsnedsättning, sämre allmänt hälsotillstånd, större besvärsutbredning), fler hinder för behandlingen (lägre förväntningar) och uppvisade andra demografiska faktorer (yngre individer, fler kvinnor) än de som tränade oftare (HB). I Delstudie II studerades hur patienter själva beskriver anledningen till avbrott i behandlingen, om dessa anledningar kan variera och hur de varierar. Sexton patienter som avbrutit sin behandling intervjuades med öppna frågor. Intervjun inleddes med en fråga om bakgrunden till den sjukgymnastiska behandlingen. De ställdes inför frågor som hade anknytning till genom!örandet av behandlingen och vad de trodde själva om sina besvär. Frågor om patienternas prioriteringar i vardagen ingick, vilka antogs kunna utgöra hinder för behandling under en kortare eller längre tid. Ett tredje område som ingick, rörde deras erfarenheter av patient/sjukgymnast relationen. Intervjuerna analyserades kvalitativt. Analysen i Delstudie II resulterade i att fyra olika beskrivningar av orsaker till avbrott i behandlingen genererades. A) Det var dags att avsluta och gå vidare på egen hand. B) Behandlingen var inte det viktigaste att lägga sin tid på. C) Överenskommelse med sjukgymnasten att avbryta behandlingen på grund av uteblivna resultat. D) Avsaknad av ställningstagande till avbrott i behandlingen. Vid en fårdjupadanalys av kategori D framstod att denna grupp erfar olika former av maktlöshet. Det yttrade sig i beskrivningar av att deras trovärdighet ofta är ifrågasatt, att deras livssituation är en ständig frustration där andra tar de viktiga besluten och där de själva inte har mycket att säga till om, samt att de värjer sig mot att berätta om sina fåreställningar om vad de själva tror besvären beror på och vad man gör åt dem. Vid en jämförelse mellan kategori D och A, B, C har kategorierna A, B och C varierande grad av kontroll i olika situationer medan kategori D saknar kontroll.

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El objetivo de la presente investigación fue describir los atributos conceptuales de la muerte desde la óptica de la enfermera como cuidadora del paciente oncológico en fase terminal Chiclayo, 2023. El método propuesto para el estudio fue cualitativo-descriptivo. La Población lo conformó 20 enfermeros de la Red Lambayeque. La selección de los participantes se realizó por conveniencia, con muestra no probabilística, determinada por saturación y redundancia de los discursos. La técnica de recojo de información fue la entrevista semiestructurada con preguntas abiertas a profundidad, validada por juicio de expertos y registrada en un grabador de voz. El procesamiento de los datos se realizó mediante la Teoría fundamentada. Se garantizó la calidad científica y rigor ético de la investigación. Resultados: Se obtuvo tres Categorías: Categoría I: El sentir ante la muerte, subcategorías: límite natural, frustración ante las pérdidas, afectividad perturbada, rechazo a la muerte y descanso a sus sufrimientos. Categoría II: Espiritualidad y cuidado, subcategorías: La Espiritualidad en Enfermería: Separación de la Dualidad Cuerpo-Alma, Resignación ante la Voluntad Divina, Esperanza de una Vida Mejor. Coexistir con la Muerte mediante el Cuidado: Identificación y Acompañamiento, Cuidado Humanizado como un Arte de Cuidar y Descanso a sus Sufrimientos. Categoría III: Resiliencia de la enfermera, subcategorías: Evolución del significado de la muerte, valorar la vida y preparado para morir. La muerte es un hecho trascendental y único, es así como para el personal de enfermería que cuida del paciente oncológico tiene una conceptualización singular resultado de sus experiencias previas, saber y costumbres. / The objective of this research was to describe the conceptual attributes of death from the perspective of the nurse as caregiver of the terminally ill cancer patient Chiclayo, 2023. The method proposed for the study was qualitative-descriptive. The population was made up of 20 nurses from the Lambayeque Network. The selection of participants was made for convenience, with a non-probabilistic sample, determined by saturation and redundancy of the discourses. The information-gathering technique was a semi-structured interview with in-depth open questions, validated by expert judgement and recorded on a voice recorder. Data processing was carried out using Grounded Theory. The scientific quality and ethical rigor of the research were guaranteed. Results: Three categories were obtained: Category I: Feeling in the face of death, subcategories: natural limit, frustration in the face of losses, disturbed affectivity, rejection of death and rest from their sufferings. Category II: Spirituality and Care, subcategories: Spirituality in Nursing: Separation of Body-Soul Duality, Resignation to the Divine Will, Hope for a Better Life. Coexisting with Death through Care: Identification and Accompaniment, Humanized Care as an Art of Caring and Resting from their Sufferings. Category III: Nurse resilience, subcategories: Evolution of the meaning of death, valuing life and preparing to die. Death is a transcendental and unique event, which is how for the nursing staff who take care of the cancer patient it has a unique conceptualization resulting from their previous experiences, knowledge and customs.

Ziel: Die beiden primären Ziele der Diabetes-Therapie sind eine möglichst optimale Einstellung des Blutzuckers sowie der Erhalt einer vergleichsweise guten Lebensqualität. Für beide Therapieziele konnte eine Vielzahl somatischer und psychischer Determinanten identifiziert werden. Relativ wenig Beachtung fand in diesem Kontext jedoch bislang die Bedeutung der therapeutischen Beziehung. Die vorliegende Dissertation untersucht, inwieweit ein unmittelbarer Zusam-menhang zwischen der Behandlungszufriedenheit der PatientInnen und den beiden anvisierten Therapiezielen besteht. Methodik: 650 PatientInnen (475 Insulin-behandelt, 171 nicht Insulin-behandelt) aus einer universitären Poliklinik, 3 Schwerpunktpraxen und 28 hausärztlichen Einrichtungen wurden befragt. Zur Erfassung der therapeutischen Beziehung wurde die Medical Interview Satisfaction Scale (MISS) verwendet, die Lebensqualität wurde mit dem WHOQOL-BREF gemessen und die Beurteilung der Blutzuckereinstellung erfolgte durch HbA1c-Werte. Die Darstellung der Ergebnisse erfolgte getrennt für mit und ohne Insulin behandelte PatientInnen. Ergebnisse: Für keines der beiden Subkollektive konnte ein Zusammenhang zwischen therapeutischer Beziehung und Blutzuckerkontrolle gefunden werden. Hingegen zeigte sich für beide Therapiegruppen eine signifikante Beziehung zu verschiedenen Aspekten der subjektiv wahrgenommenen Lebensqualität. Schlussfolgerungen: Unterschiede in der Blutzuckereinstellung waren mit der gewählten Methodik sowie dem verwendeten Konstrukt (Behandlungszufriedenheit) in dieser naturalistischen Studie nicht aufzuzeigen und ein Einbeziehen weiterer Dimensionen der therapeutischen Beziehung, insbesondere der ärztlichen Perspektive und der jeweiligen Interaktion, erscheint für weitere Untersuchungen wünschenswert. Auch wenn die signifikanten Ergebnisse in der Interaktion mit Lebensqualität z.T. als gemeinsame Kovarianz zu verschiedenen Persönlichkeitsmerkmalen interpretiert werden können, ergeben sich deutliche Hinweise, dass die therapeutische Beziehung ein Einflussfaktor der gesundheitsbezogenen Lebensqualität ist. / Objective: The primary goals in treating Diabetes are maintaining blood glucose levels as close to normal as possible and making a relatively normal quality of life achievable. A multitude of somatic and psychological determinants for both of these goals could be identified. However, relatively little consideration in this context was given to the importance of the doctor-patient-relationship. This study examines, whether a direct relationship between treatment satisfaction and the primary treatment goals exists. Methods: 650 patients (475 insulin-treated, 171 not insulin-treated) from one universitary outpatient centre, 3 specialized treatment facilities and 28 general practitioners were asked. The doctor-patient-relationship was assessed using the Medical Interview Satisfaction Scale (MISS), health-related quality of life was measured by the WHOQOL-Bref and metabolic control by HbA1c values. Results are presented separately for patients treated with and without insulin. Results: For none of the two subgroups a relationship between doctor-patient-relationship and metabolic control was detected. However, significant interactions were found for both collectives regarding different aspects of quality of life. Conclusions: Differences in metabolic control could not be shown using the chosen methods and the construct treatment satisfaction under routine conditions and further dimensions of the doctor-patient-relationship as the physician's perspective and interactional aspects are likely to be included in future studies. Even while the significant results concerning the interaction with quality of life can be interpreted as a common covariance regarding various personality dispositions there are clear indications that the doctor-patient-relationship is a determinant of health-related quality of life.

The purpose of this study was to investigate and describe the experience of infertility of African women, men and family member. It is hoped that this description will contribute to a deeper understanding of the psychosocial difficulties involved in the area of infertility and ofthe ways in which people respond to the situation of infertility. A qualitative research approach was used, and in particular social constructivist-interpretive research and feminist research approaches. The sample consisted of39 participants: 19 women, 10 men, and 10 family members faced with infertility. The research orientation was field-based, concerned with collecting data using the technique of in-depth semi-structured interviews. Each participant was interviewed individually. The interviews were recorded on tape, transcribed in their full length and translated into English. Data were analysed on the basis of the interpretive feminist approach. Analysis of individual cases and crosscase analysis were employed. The findings suggested a contextual definition of infertility, for example, for some, having had an ectopic pregnancy or a miscarriage meant that they did not fit into the definition of infertility. The findings revealed that for many African women and men, blood ties still defined the family and the persona. Thus, failure to have a blood child resulted in courtship and marital break up, extramarital relationships, polygamy, and divorce and remarriage. Infertility had serious psychosocial consequences for both the infertile individuals and their families. Participants experienced repeated periods of existential crisis, which began at different points for different participants. Analysis of gender differences indicated similarities in the experience of the crisis, but differences in terms of expression and ways of responding to the crisis. Family dynamics within the context of infertility were coloured by ambivalent feelings, resentment, insensitivity, and miscommunication, but also affection, and social support. Traditional and modern medical health systems offered the possibility of finding explanations and treatment, but there was further strain from the negative experiences with the health care system. The findings in this study suggested the need for policy reformulation, for psychosocial intervention as part of the treatment plan, and for future research on the outcome of using various coping strategies. / Psychology / D. Phil. (Psychology)

This dissertation reports on the lived experiences of four child psychiatric nurses. The territory of child psychiatric nursing is explored in this investigation through the punctuation of many voices within this field of study. The methodology of the investigation is descriptive phenomenology and Colaizzis’ steps in descriptive phenomenology (map) are used to discover and describe the different template theories (the territory) that are unique to each of the four child psychiatric nurses who were interviewed. Following this, a story is punctuated, which is referred to as the structural synthesis. It is the heartbeat of the investigation. The dissertation concludes by reflecting on the paradox of how the invisibility of the child psychiatric nurses allowed for the visibility of the dissertation and encourages the reader to ask pivotal questions about the important role of the child psychiatric nurse, working as part of a multidisciplinary team, in order to improve patient care. / Psychology / M.A. (Clinical psychology)

Transcultural nursing refers to the provision of nursing care to patients whose values, beliefs and life-style differ from those of the nurse. To enable nurses to honour their ethical obligation to provide quality care, they must have the necessary knowledge to nurse patients across cultural boundaries. This study was conducted to determine the nurse's knowledge of and attitudes towards the culturally different patient. A questionnaire was used to collect the data. Although nurses see it as a challenge to nurse patients from different cultures, it was found that they do not have the necessary knowledge to provide culture-sensitive care. Other factors, such as the nurse's attitude towards culturally different patients, communication problems, mistrust, prejudice and a lack of understanding of cultural uses and traditions, contribute to the lack of culture-sensitive care. The nursing profession should pay attention to these problems. / Health Studies / Van Tonder, Sally / M.A. (Nursing)