Magister Curationis - MCur / Depression is defined as a psychiatric condition, wherein a person experiences extreme sadness, social withdrawal, and expresses self-deprecating thoughts. Across the world, millions of people with Human Infectious Virus (HIV) suffer from depression each year. Depression is regarded as the most common disabling medical condition that affects both HIV-positive and HIV-negative individuals, globally. It is further reported that depression is the most common neuropsychiatric disturbance observed in HIV infected individuals. In South Africa, the prevalence of depression symptoms among Antiretroviral Therapy (ART) clients is reported to be 25.4%. However, depression among this group is often underdiagnosed and untreated in Primary Health Care settings. The need for routine screening is encouraged by studies confirming that depression and anxiety disorders accelerate the progression of HIV disease. Methods A quantitative descriptive research design was used. The study population included 1 440 males and females, aged eighteen years and over, who were HIV positive and received ART at the Clinic. A randomly selected sample of 372 respondents were recruited, but 110 had to be excluded because of eligibility issues; therefore, 262 respondents completed the Beck Depression Inventory (BDI) questionnaire. Mann-Whitney U test, Fisher’s exact test and the Spearman Rank test were used to analyse the data, using GraphPad Prism software. Depression symptoms were evaluated, using BDI, and a score of -> 10 indicated depression. Results Of the 262 respondents, 52% had club membership, compared to 48%, who were only on ART. There were significantly more female respondents (44%) involved in Adherence Clubs, as opposed to their male counterparts (8%), a difference of 36% overall (p=0.016). In summary, the number of individuals, who were suffering from some form of depression, enrolled in ART Adherence Clubs was 8.4% of the total sample, compared to 10% of those who were not in ART adherence clubs. The overall prevalence of depression in this current study was 18.4 %, which was in line with other studies conducted in a South African context, and a similar setting. Clinical depression status represents the main outcome of interest in this research project. The model category was 0-10, which indicated that a significant majority, 69.5%, n= 182, of the enrolled respondents were classified as healthy, in terms of clinical depression status. Beck depression scores were consistent across gender. Depression seemed to be more severe in the 35-44 age category. Fisher’s exact test confirmed the absence of any statistical difference between ART club membership and their depression status. Spearman rank correlation coefficient of -0.02 indicates a very low association between length of HIV seropositivity and Beck Depression score. Conclusion This is the first study reporting on the prevalence of depression, in relation to HIV infection, as well as ART treatment, and the associated adherence programme in Cape Town. Further research on a similar topic is recommended, using other instruments in the same geographic area.

Bakgrund: Att vårdas mot sin vilja medför en komplicerad vårdsituation, trots detta måste patienten kunna erbjudas en god humanistisk psykiatrisk hälso- och sjukvård på lika villkor. Att bli utsatt för tvångsåtgärder under vårdtiden kan medföra trauma och skadar behandlingsalliansen med patienten. Således blir en av de viktigaste faktorerna för att kunna uppnå en god psykiatrisk vård att i största möjliga mån försöka undvika tvångsåtgärder under vårdtiden. Syfte: Syftet med studien var att belysa patienters uppfattning av faktorer som bidrog till tvångsåtgärder. Metod: Studien utfördes som en kvalitativ litteraturstudie och utgick från sökningar i de vetenskapliga databaserna, PubMed, Cinahl och PsycINFO. Åtta kvalitativa artiklar inkluderades i resultatet, vilka alla var utförda i nordiska länder. Studierna analyserades genom en metasyntes som utgick ifrån Thomas & Hardens metod för tematisk syntes. Resultat: Det framkom att patienterna tyckte att det var personalen som i stor omfattning bidrog till att tvångsåtgärder blev nödvändiga. Sexton första nivåns teman identifierades i artiklarna. Fyra andra nivåns teman framkom där bland annat maktfaktorer, brister hos personalen och bristande delaktighet framkom, vilket slutligen mynnade ut i två resultatteman: Tvångsvård kunde skapa en maktobalans som missbrukades och ledde till onödiga tvångsåtgärder och starkare mellanmänskliga relationer mellan vårdare och vårdtagare bidrog till en mer personcentrerad vård som minskade antalet tvångsåtgärder. Efter bedömningen av GRADE CERQual framkom att det är möjligt att fyndet är en rimlig representation av fenomenet. Konklusion: För att kunna minska antalet tvångsåtgärder måste patienternas perspektiv stå i fokus, vilket innebär en personcentrerad vård där personalen utgår ifrån patientens synvinkel och behandlar dem som likvärdiga människor så att de kan vara mer delaktiga i sin vårdprocess. / Background: Being cared for against one's will entails a complicated care situation, despite this, the patient must be able to be offered good humanistic psychiatric health care. Being subjected to coercive measures during the care can lead to trauma and damage the treatment alliance with the patient. One of the most important factors to be able to achieve good psychiatric care is to try as much as possible to avoid coercive measures during the care. Aim: The aim of the study was to shed light on patients' perceptions of factors that contribute to coercive measures.Method: The study was conducted as a qualitative literature study and was based on searches in the scientific databases, PubMed, Cinahl and PsycINFO. Eight qualitative articles were included, all were made in the Nordic countries. The studies were analyzed through a meta-synthesis based on Thomas & Harden's method for thematic synthesis. Results: It emerged that the patients thought that it was the staff who to a large extent contributed to the necessity of coercive measures. Sixteen first-level themes were identified in the articles. Four second-level themes emerged where, among other things, power factors, staff shortcomings and lack of participation emerged. Which ultimately resulted in two result themes: Compulsory care could create a balance of power that was abused and led to unnecessary coercive measures, and stronger interpersonal relationships between caregivers and care recipients contributed to a more person-centered care that reduced the number of coercive measures. After the assessment of GRADE CERQual, it emerged that it is possible that the finding is a reasonable representation of the phenomenon.      Conclusion: To reduce the number of coercive measures, the patients' perspective must be in focus, which means a person-centered care where the staff starts from the patient's point of view and treats them as equal people so that they can be more involved in their care.

Bakgrund: Relationen till patienter inom den psykiatriska vården utgjorde grunden i psykiatrisk omvårdnad. Patienter med schizofreni upplevde att relationen kunde förbättras. Sjuksköterskor upplevde det svårt att få utrymme för att skapa relation. Syfte: Var att belysa sjuksköterskors upplevelser av relationen till patienter med schizofreni. Metod: En litteraturöversikt med 19 granskade vetenskapliga originalartiklar. Litteratursökning genomfördes i Cinahl, PubMed och PsycINFO. Resultatet sammanställdes med en kvalitativ innehållsanalys. Resultat: Sjuksköterskor upplevde förutsättningar, hinder och betydelse för relation. Förutsättningar var att skapa tillit, att mötas på samma nivå, att förstå helheten samt att inge hopp. Hinder var brist på kompetens, sjukdomsbilden samt organisatoriska brister. Betydelse var att vara trygg i sin roll och att vara ett stöd. Diskussion: De olika delarna som framkom i resultatet var beroende av varandra på olika sätt. Genom att relationen förbättrades kunde patienters livsproblem synliggöras och främja den psykiska hälsan. Slutsats: Kunskap om relationens betydelse ökade och sjuksköterskan fick ytterligare verktyg för att förbättra relationen till patienter med schizofreni. / Background: The relationship with patients in psychiatric care was the basis of psychiatric nursing. Patients with schizophrenia felt that the relationship could be improved. Nurses found it difficult to get space to create a relationship. Purpose: To elucidate nurses' experiences of the relationship with patients with schizophrenia. Method: A literature review with 19 original scientific articles reviewed. Literature search was conducted in Cinahl, PubMed and PsycINFO. The result was compiled with a qualitative content analysis. Results: The result showed that nurses experienced different factors in possibilities, obstacles and significance for the relationship. The possibilities were to create trust, to meet at the same level, to understand the whole and to give hope. Obstacles were a lack of skills, the disease picture and organizational deficiencies. Significance was being confident in their role and being a support. Discussion: The different parts that emerged in the result depended on each other in different ways. By improving the relationship, patients' life problems could be made visible and promoted mental health. Conclusion: Knowledge about the importance of the relationship increased and the nurse was given additional tools to improve the relationship with patients with schizophrenia. / <p>Godkännandedatum: 2020-01-16</p>

Bakgrund: Globalt har substansmissbruk blivit ett växande problem och oron har ökat gällande omfattningen av olagliga droger inom den psykiatriska vården. Det har blivit vanligare med substansbrukssyndrom bland personer med psykisk ohälsa jämfört med befolkningen i övrigt, vilket har lett till att fler sjuksköterskor möter dessa patienter inom den psykiatriska vården. Syfte: var att belysa sjuksköterskors erfarenheter av att vårda patienter med samsjuklighet av psykisk ohälsa och substansbrukssyndrom, inom psykiatrisk vård. Metod: en litteraturstudie baserad på 13 vetenskapliga artiklar genomfördes och analyserades med en kvalitativ design. Analysen ledde fram till två kategorier och sju underkategorier. Resultat: visade att sjuksköterskorna inom den psykiatriska vården såg flera utmaningar i vårdprocessen, såsom bristande rutiner och kunskapsbrist, men även möjligheter i sin vård av dessa patienter. Sjuksköterskorna efterlyste tydligare rutiner, bättre samverkan och mer utbildning om missbruk. Diskussion: Beskriver vikten av tydliga rutiner och samverkan i kombination med behovet av adekvat kompetens hos sjuksköterskorna. Slutsats: Tydligare rutiner, med förbättrad samverkan till omgivande instanser skulle i kombination med utbildning, förbättra omvårdnaden till patienterna. / Background: Globally, substance abuse has become a growing problem and concerns have increased regarding the extent of illicit drugs in psychiatric care. Substance use syndrome has become more common among people with mental illness compared to the general population, which has led to more nurses meeting these patients in psychiatric care. Aim: was to elucidate nurses' experiences of caring for patients with mental illness and substance use syndrome, in psychiatric care. Method: a literature study based on 13 scientific articles was conducted and analyzed with a qualitative design. The analysis led to two categories and seven subcategories. Result: showed that the nurses in psychiatric care saw several challenges in the care process, such as lack of routines and lack of knowledge, but also opportunities in their care of these patients. The nurses called for clearer routines, better collaboration and more education about abuse. Discussion: describes the importance of clear routines and collaboration in combination with the need for adequate expertise among the nurses. Conclusion: clearer routines, with improved collaboration with surrounding agencies, in combination with education, would improve the care of patients. / <p>Godkännandedatum: 2020-01-15</p>

Bakgrund: Begreppet personcentrerad har internationellt blivit vedertaget inom omvårdnadsvetenskap och används för att beskriva en vårdform där vården utgår från ett partnerskap med patienten. Engagemang, trygghet, tillit, att vara delaktig i planeringen av vården och en vårdande relation upplevs vara viktiga komponenter som främjar delaktigheten. För att öka förståelsen om delaktighetens och personcentreringens syfte inom den rättspsykiatriska vårdkontexten krävs studier som beskriver de mångfacetterade begreppen ur vårdarens och patientens perspektiv. Syfte: Att förstå upplevelser av delaktighet och personcentrerad vård hos patienter och personal på en rättspsykiatrisk avdelning och diskutera hur delaktighet kan möjliggöras. Design: Studien är en kulturanalys och ansatsen är hermeneutisk. Metod: Enskilda halvstrukturerade intervjuer med fyra vårdare och fyra patienter på en rättspsykiatrisk avdelning i Mellansverige genomfördes. Intervjuerna har bearbetats utifrån en kulturanalytisk hermeneutisk arbetsmodell i sju faser. Interna dokument från sjukhuset analyserades avseende delaktighet. Resultat: Oklarheter gällande vårdprocessen och rättspsykiatrins strukturer som är inte fullkomligt tydliga inverkar på upplevelsen av delaktighet. Konklusion: Personal och patienter har olika uppfattningar om strukturernas funktion. Personalen anser att patienternas delaktighet är en förutsättning för vårdprocessen. Patienter uttrycker osäkerhet kring vad som förväntas av dem. Identitet och tolkning av den egna rollen kan påverka delaktigheten hos patienter inom rättspsykiatri. / Background: The concept of person-centered care is internationally accepted in nursing science and describes a form of care with an active patient included in all aspects of care. Commitment, trust, and involvement in the planning of care and a caring relationship are perceived to promote participation. To increase understanding person-centering in the forensic psychiatric care context, studies on the multifaceted concepts from carers’ and patients’ perspectives are required. Aim: To understand experiences of participation and person-centered care among patients and staff in a forensic psychiatric ward and discuss how participation can be promoted. Method: Individual semi-structured interviews with four carers and four patients in a forensic psychiatric hospital in Central Sweden were conducted. A seven-phase cultural analysis model was used. Internal documents were analyzed for statements about participation. Design: The study is a cultural analysis with a hermeneutic approach. Result: Unclear care process and structures of forensic care affect the experience of participation. Conclusion: The perceptions of the function of the structures differ. Staff believe that patient participation is a prerequisite for the care process. Patients express uncertainty about what is expected of them. Identity and interpretation of one's own role can influence the participation of patients in forensic psychiatry.

Homosexuality is something which has been a part of almost every society throughout history. In western society this has been a subject of secrecy and taboo. Throughout our history homosexuals have been persecuted and forced to hide their sexual identity. The effects of this on an individual should be something of concern to professionals in the mental health field. While in the past there has been little knowledge of homosexuality, and no self-expression on the part of homosexuals, there has, in recent years, been growing information and expression. The effect of this change on mental health workers is what this paper will examine. An historical survey will present the forces which shaped the current attitude of the mental health profession about homosexuality. I will present a general examination of the social ideology toward homosexuality in western society. I will also review the history of those homosexuals who have banded together for companionship, reform, and protest. This will be a context against which I will examine the attitudes of a specific group of people who care for the mentally ill--nurses and aides at a state mental hospital. The questionnaire I used to examine their attitudes surveys a broad range of possible attitudes about homosexuality. The responses will demonstrate what changes have occurred in society’s attitudes toward homosexuality. It will show, specifically, what the attitudes are of those who care for economically disadvantaged, severely disturbed homosexuals.

Bakgrund: Att leva med en psykisk ohälsa är en stor påfrestning och utmaning för den som drabbas. De psykiska besvären begränsar personens vardagliga funktion och kan därmed påverka dennes privata och sociala liv. Ännu idag kan en person med psykisk ohälsa drabbas av fördomar och utsättas för stigmatisering. Tyvärr gäller detta inte bara i samhället utan dessa fördomar kan även finnas bland personer som jobbar inom vården. För att den drabbade ska kunna må bättre måste personen söka professionell hjälp och de som ska ge hjälpen måste ha kunskap om hur man bör göra det på bästa sätt. Syfte: att belysa sjuksköterskors attityder i mötet med personer som lider av psykisk ohälsa. Metod: Författarna valde att genomföra en icke-systematisk litteraturöversikt, som inkluderar 15 vetenskapliga artiklar med både kvantitativa och kvalitativa designer. Artiklarna söktes i tre databaser: PubMed, CINAHL och PsycInfo. Alla inkluderade artiklar granskades med hjälp av Sophiahemmets högskolas bedömningsunderlag samt analyserades med hjälp av Fribergs integrerade analysmetod. Resultat: Studien visar att det finns olika attityder hos sjuksköterskor till patienter med psykisk ohälsan samt att dessa har stor påverkan på omvårdnad och patientens återhämtningsprocess. Resultaten presenteras i tre kategorier som inkluderar patientens upplevelse av sjuksköterskans attityder och omvårdnad, sjuksköterskans attityder och omvårdnad samt faktorer som påverkar sjuksköterskans attityder och omvårdnad. Huvudfynden i studien är att sjuksköterskans attityder styrs av faktorer som kultur och stigma, vårdkultur, organisation och tidsbrist på avdelningar samt sjuksköterskans kunskap och erfarenhet. Slutsats: Ju större kunskap sjuksköterskan har, desto mer positiva attityder uppvisar hen till patienter som lider av psykisk ohälsa. Det finns behov av att utveckla medvetenheten hos sjuksköterskor om hur deras attityder kring personer med psykisk ohälsa påverkar omvårdnad och återhämtning. De drabbade behöver stöd och förståelse från sjuksköterskorna för att kunna skapa ett förtroende för vården och en vilja att söka hjälp. / Background: Living with a mental illness is a great stress and challenge for those affected. The mental disorders limit the person's everyday functionality and can thus affect his or her private and social life. Nowadays, a person with mental illness is still facing prejudices that have their roots in stigmatization. Unfortunately, this applies not only to society, but also to the professionals working in healthcare. In order for the affected person to feel better, the person must seek professional help and those who give the help must have knowledge of how to treat them. Aim: The aim of this study was to elucidate the nurse's attitudes in meeting persons suffering from mental illness. Method: The authors chose to carry out a non-systematic literature review which includes 15 scientific articles with quantitative and qualitative design. Scientific articles were found in 3 databases: PubMed, CINAHL and PsycInfo. All included articles were quality reviewed according to Sophiahemmet University's assessment documentation and analyzed with the help of Friberg's integrated analysis method. Results: The study shows that there are different attitudes of nurses to patients with mental illness and that these have a major impact on nursing and the patient's recovery process. The results are presented in three categories which include the patient's experience of the nurse's attitudes and nursing, the nurse's attitudes and nursing as well as factors affecting the nurse's attitudes and nursing. The main finding in the study is that the nurse's attitudes are governed by factors that culture and stigma, nursing culture, organization and lack of time in departments and the nurse's knowledge and experience. Conclusions: The greater the knowledge the nurse has, the more positive attitudes they show to patients suffering from mental illness. There is a need to develop awareness among nurses about how their attitudes about people with mental illness affect nursing and recovery. Patients need support and understanding from nurses in order to build trust in care and a desire to seek help.

Bakgrund: Psykisk ohälsa präglas ofta av samsjuklighet och/eller komplexa behov som försvårar bedömningar. Suicid är ett globalt folkhälsoproblem och hälso- och sjukvården skall arbeta med suicidprevention för att undvika vårdskador av såväl given som utebliven vård och omvårdnad. Tusentals personer utför självmordsförsök varje år och det är vanligare att dö i fullbordat suicid än i trafikolycka i Sverige. Sjuksköterskor träffar prehospitalt frekvent suicidnära patienter. Suicidriskbedömning är komplext och dess kvalité beror på kompetens och erfarenhet. Bristfällig suicidriskbedömning kan leda till undvikbara vårdskador för patienter. Syfte: Att undersöka och beskriva upplevelser och erfarenheter av suicidriskbedömning prehospitalt. Metod: Mixad metod av kvantitativ och kvalitativ design bestående av enkät och semistrukturerade intervjuer med sjuksköterskor i ambulanssjukvården. Resultat: Sjuksköterskor upplevde stress, oro och fysiska symtom som ont i magen och tungt i bröstet på väg fram till suicidnära patienter liksom känsla av osäkerhet och otillräcklighet gällande bedömning och bemötande. Sjuksköterskor upplevde skyldighet att förebygga suicid och de flesta hade både identifierat suicidnära patienter liksom utfört suicidriskbedömning prehospitalt utan att ha fått utbildning i det. Diskussion: Resultatet överensstämde med tidigare forskning gällande negativa upplevelser av att möta suicidnära patienter. Slutsats: Sjuksköterskor mötte frekvent suicidnära patienter och utförde suicidriskbedömningar samtidigt som de hade negativa känslor inför mötet med suicidnära patienter och upplevde sig ha varierande såväl reell som formell kompetens för suicidriskbedömning. / Background: Mental illness often characterizes by comorbidity and / or complex needs that complicate assessments. Suicide is a global public health problem and health services must work with suicide prevention to avoid injuries from poor assessment. Thousands of people commit suicide attempts every year and it is more common to die in suicide than in a traffic accident in Sweden. Nurses frequently see suicidal patients outside of hospital. Suicide risk assessment is complex, and its quality depends on competence and experience. Poor suicide assessment could lead to avoidable injuries in patients. Aim: To investigate and describe experiences of suicide risk assessment in emergency setting outside of hospital. Method: Mixed method consisting of quantitative and qualitative design with questionnaire and semi structured interviews with nurses. Results: Nurses experience stress, anxiety, and physical symptoms such as pain in the stomach and heavy feeling in the chest on the way to suicidal patients as well as feelings of insecurity and inadequacy regarding assessment and treatment. Nurses feel an obligation to prevent suicide, and most have both identified suicidal patients as well as performed a suicide risk assessment prehospital without having received training in it. Discussion: The results was consisted with previous research about negative emotions when caring for and assessing the suicidal patient. Conclusion: Nurses frequently meet suicidal patients and perform suicide risk assessments. At the same time, they have negative feelings towards meeting suicidal patients and have a variety of both real and formal competence for the task of suicide risk assessment. / <p>Datum för godkännande: 2022-01-17</p>

Background: Every year, many patients with mental health problems are admitted to compulsory care under the Compulsory Psychiatric Care Act (LPT). There is a significant risk of patients injuring themselves or others. To prevent these risks, coercive measures which often infringe patients’ privacy and restrict their autonomy are employed. Therefore, it is crucial to consider patients' experiences of coercive measures to protect their privacy, autonomy and to reduce the need for coercive measure by providing person-centered care. Aim: The aim of the literature review was to describe adult patients' experiences of coercive measures in psychiatry. Method: Structured literature review with a qualitative approach is used. Fifteen scientific articles were identified using three databases: PubMed, CINAHL, PsycInfo. Two additional articles were found via Google Scholar and included. Data was analyzed using thematic analysis. Results: Participants described negative and to some extent positive experiences with coercion measures. Three themes were identified: Negative experience regarding health, vulnerability and autonomy, Positive experience of coercive measure and alternative measures, and participation and communication were described as the experience of the patients. Conclusion: Coercive measures have both negative and positive experiences where the negatives can be mitigated through effective communication with patients. In addition, nurses play a significant role in providing patients person-centered care in the context of coercive measures.

Bakgrund: Samtidigt som andligt utövande hos personer med psykossjukdom påverkar faktorer såsom välbefinnande, återhämtning och läkemedelsföljsamhet upplever dessa patienter att den andliga dimensionen inte tas i beaktning av sjuksköterskan i omvårdnaden. För att förbättra den holistiska omvårdnaden är det således av vikt att få en ökad förståelse för sjuksköterskans erfarenhet av andlig omvårdnad till patienter med psykossjukdom. Syfte: Att beskriva psykiatrisjuksköterskans erfarenhet av andlig omvårdnad till patienter med psykossjukdom. Metod: Kvalitativ litteraturöversikt med systematiskt tillvägagångssätt. Betydelse: Genom att undersöka psykiatrisjuksköterskans erfarenheter av andlig omvårdnad hos patienter med psykossjukdom kan vi öka vår kunskap kring hur den andliga dimensionen kan integreras i omvårdnaden. Resultat: Tre huvudteman formulerades: Sjuksköterskans förutsättningar; Definitionen av andlighet, Sjuksköterskans egna trossystem, Sjuksköterskans personliga egenskaper. Hindrande faktorer; Kunskapsbrist, Strukturella faktorer, Stigma. Främjande faktorer; Vårdrelationen, Livsberättelsen som verktyg, Andligt empatiskt förhållningssätt, och Betydelsen av klinisk erfarenhet. Slutsats: Andlighet i vårdkontexten behöver definieras och andlig omvårdnad behöver utformas och implementeras i omvårdnaden. Sjuksköterskor behöver kunna prata om den andliga dimensionen och ha självkännedom om den egna andligheten. Sjuksköterskor behöver ha kunskap i kulturell och religiös normativitet samt hur andliga uttryck kan skiljas från psykotiska symtom, vilket behöver integreras i läroplanen. / Background: Whilst practicing spirituality among people with psychotic illness affects factors such as well-being, recovery and compliance, the experiences of these patients is that the nurse does not take this dimension into consideration in the nursing care. To improve holistic care, it is therefore of importance to increase knowledge revolving the nurse’s experiences of spiritual care to patients with psychotic illnesses. Aim: The aim of this study was to describe psychiatric nurses’ experiences of spiritual care to patients with psychotic illnesses. Method: A qualitative literary study with a systematic approach. Meaning: By examining the psychiatric nurses’ experiences of spiritual care amongst patients with psychotic illness, we hope to increase the knowledge in how the spiritual dimension can be integrated into nursing care. Result: Three main themes were formulated: The nurses' prerequisite qualification; The definition of spirituality, The nurses' own belief system, The nurses' personal presumptions. Impeding factors: Lack of knowledge, Structural factors, Stigma. Promoting factors; The nurse-patient relationship, The life story used as a tool for continued care, The spiritual empathic approach, and The importance of clinical experience. Conclusion: Spirituality in the context of care needs to be defined, and spiritual care needs to be adequately shaped and applied in nursing. Nurses need to be able to discuss the spiritual dimensionand possess a self-awareness regarding their own spirituality. Nurses require knowledge concerning cultural and religious normativity, and how displays of spirituality can be distinguished from psychotic symptoms, which needs to be included in the nursing curriculum.