Att möta och stödja närstående till svårt sjuka patienter är en av sjuksköterskans många uppgifter. Författarparet har genomfört en empirisk kvalitativ intervjustudie om hur närstående uppfattar att de blivit bemötta inom kirurgisk verksamhet. Semistrukturerade intervjuer genomfördes med fem stycken deltagare vars anhöriga vårdas eller vårdats för malign sjukdom i övre mag- tarm kanalen inom kirurgisk verksamhet. Syftet med studien var att få ökad kunskap i hur närstående uppfattar bemötandet. Vidare var syftet att ta reda på hur anhöriga önskar bli bemötta. Resultatet visade att närstående uppfattade brister i bland annat informationen och stödet de fick från personalen. / One of many tasks that nurses have is to meet and support significant others to severely ill patients. The authors´ aim with this empirical qualitative study was to examine how significant others get treated by hospital staff in surgery care sector. Semi structured interviews were held with five significant others to patients who were treated for cancer diseases in a surgical division. The aim of this study was to improve the knowledge of how significant others perceive the treatment they got from the hospital staff. Furthermore was the aim to examine how significant others would like to be received by the hospital staff. The results of this study showed that significant others had experienced, that the availability of information and support from the hospital staff, were inadequate.

INTRODUCTION: Despite evidence showing that tinnitus can have a detrimental impact on significant others (SOs), no standardized self-reported measure is currently available that specifically assesses the presence of third-party disability for tinnitus. The aim of this study was to develop and assess the psychometric properties of a newly developed self-reported measure for SOs of tinnitus and assess how scores could be meaningfully interpreted. METHODS: The research consisted of two phases. During Phase I, the Consequences of Tinnitus on Significant Others Questionnaire (CTSOQ) was developed using the The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidance. Phase II included the assessment of psychometric properties of the CTSOQ including the construct validity, internal consistency, interpretability, and responsiveness. Pairs of 194 individuals with tinnitus and their SOs completed a series of online questionnaires. SOs completed the CTSOQ measure while individuals with tinnitus completed measures related to tinnitus distress, anxiety, depression, insomnia, and quality of life. RESULTS: A 25 item CTSOQ was developed using a formative model. The questionnaire validation process indicated good psychometric properties with an internal consistency of 0.93 and inter-item correlation of 0.60. Support was found for the construct and discriminative validity of the measure. Floor and ceiling effects were negligible. Scores can be meaningfully interpreted to indicate mild, significant, or severe effect of tinnitus on SOs. The questionnaire was also found to be responsive to treatment-related changes. CONCLUSIONS: The CTSOQ was found to have sufficient measurement properties suggesting that it is a suitable measure of third-party disability for SOs of individuals with tinnitus. Further research should be initiated to measure face validity and what scores reflect clinically meaningful change.

本個案研究旨在探討實施聽力策略教學對四位台灣國中生的影響與衝擊。 不同於以往傳統認知取向的策略教學，本文採用維高斯基（Vygotsky）社會文化取向理論來分析學生的學習；相信策略教學與學習應該考量到學生與外界環境及人際間的互動，而非只探討教學本身的成效。因此本研究在個案對策略學習及自主學習的觀感和態度上多所著墨。文獻回顧內容則涵蓋聽力策略的理論及聽力策略教學實施情形及成效的研究。 　　本研究對象針對37位八年級的學生實施為期18週的聽力教學。但重心放在四位個案身上。研究方法採用質化的學生訪談及學生學習日記的分析輔以量化的聽力策略問卷。實施的步驟分為準備期、診斷期、教學期、練習期、及評估期。在教學開始前，學生們先通過全民英檢初級的聽力測試以評估其聽力能力並篩選個案。然後，實施聽力策略問卷調查以觀察學生平時使用的策略。之後，學生們接受六項聽力策略的教導，包含：猜測、分類、類推、記筆記、選擇性專注、及詢問。在教學實施期間，個案被要求寫學習日記，記錄對所學策略的感想及使用情形。學習日記及訪談是分析個案學習情形的主要資料。 第四章則著重於探討四位個案的家庭背景，學校表現，及對自主學習的態度和想法。目的是希望完整呈現四位個案不同的人格及學習特質，及之所以他們會如此學習的原因。第五章記錄了研究的兩樣重大發現： 1. 聽力能力較高的同學顯然比聽力較弱的學生更能夠有效率的交互使用「由上而下」 及「由下而上」的聽力策略。而聽力較弱的同學則傾向於過度依靠直接翻譯」策略。 2. 原本一向被傳統認知學習策略所忽略的情意方面的因素，反而似乎是影響學生策略學習的主因。這些情意方面的因素包括了：學生如何控制自己的脾氣，學習態度，及情緒。更重要的是，學生似乎都傾向於需要找到生命中的重要他人，並依靠這些較有能力的大人來提供他們踏出學習第一步時必要的安全感，知識，能力，方法及學習的動力。 因此，本研究的發現，回應了維高斯基的社會文化取向理論。唯有先透過人際間的互動與學習，才有可能回歸自我，反求諸己，達到內省與自發的境界。本研究希望能藉由教育現場的真實互動情形，喚醒策略學習及教學研究者對社會文化取向的學習理論，以及學生情意態度影響學習成效的重視。 / The purpose of this case study was to investigate four Taiwanese junior high school learners’ listening strategy use when receiving listening strategy instruction. Different from conventional quantitative SLA strategy studies, this present qualitative case study, adopting sociocultural perspectives, grounded on the conception that the issues of strategy learning should not be understood only in terms of direct instruction and its effectiveness. Instead, exploring the learning processes in which learners and the external environment are necessary. Therefore, this case study focused on the discussion of four learners’ attitude toward learning and their perspectives toward listening strategy instruction. The participants of this study were 37 students in a Taiwanese junior high school in the Taipei city. Yet, the focus was on four cases, Natalie, Tom, Jasmine and Jin Pin. Three major data collection instruments were adopted including the quantitative questionnaire, qualitative interviews and learning journals kept by the four cases. The instructional procedure was divided into five stages-- preparation, diagnosis, instruction, practice, and evaluation. A sample GEPT listening comprehension test was given to the students to pretest their proficiency in the diagnosis stage. Then the instruction on six listening strategies--guessing, grouping, inferencing, note-taking, selective attention, and asking for clarification was provided for 18 weeks. The Listening Comprehension Strategy Questionnaire based on Wang (2000) was conducted to identify the learners’ listening strategy use. Their learning journals were evaluated to explore their ongoing problems and perceptions toward learning the strategies. In Chapter Four, the profiles of the four cases were illustrated including their family background, school performance, and attitude toward learning autonomously to give a full picture of their learning habits. In Chapter Five, major findings are summarized. First, the case study echoed the previous finding that more skillful listeners seem to use both the ‘top-down’ and ‘bottom-up’ strategies more effectively while less skillful listeners rely too much on direct translation. Second, some salient issues previously not emphasized were found including learners’ affective concerns and their ability to control emotions, turned out to powerfully influence the learners’ learning. The learners needed to be assisted first by some adult surrogates and their significant others and to gain enough guidance, assurance, sense of security and control over the emotions before they can move on to self-regulated learning. If not, their learning tends to be subject to their own emotions, which are mostly controlled by the interaction between the learners and the external environment or the others. This finding consisted with the sociocultural perspective in that learning is a collaborative process between the learners and their social contexts. Only through interaction with others can learners achieve a new level of autonomy. To foster learner autonomy, strategy training needs to account for a more interactive view of learning. It also suggests that more efforts should be paid to explore the impact of learners’ affective and social concerns on their language learning toward autonomy.

Bakgrunn og hensikt: For mennesker som blir akutt/kritisk syk blir livet oftest endret på kort tid fra å værevelfungerende i hverdagen til innleggelse i intensivavdeling hvor selveste livet kan stå på spill. Tradisjonelt settblir intensivpasienter tatt vare på gjennom medisinsk kunnskap og et naturvitenskapelig kunnskapsparadigme. Åvære akutt/kritisk syk innebærer å få spesielle opplevelser og erfaringer som går ut over hverdagserfaringene, oghvordan disse erfaringene trer fram i situasjonen. Denne kunnskapen pasientene bærer i seg er ikke bareindividuell og privat kunnskap, den representerer også en form for viten som trenger å forskes fram og løftes inni det offentlige rom både folkehelsevitenskapelig og sykepleievitenskaplig, nettopp fordi den omhandler viktigeforutsetninger for at pasientene skal bli sett og møtt også eksistensielt. Denne kunnskapen representerer en annenontologi og epistemologi enn den naturvitenskapelige kunnskapen og representerer derfor et annetkunnskapsperspektiv, også når det gjelder kunnskapsformidlingen i en klinisk veiledningssammenheng. Avhandlingens overordnede mål er å øke forståelsen av det å være alvorlig syk og hvordan kunnskap ut fraerfaringer har betydning i kunnskapsformidling i en intensivkontekst. Data og metoder: Avhandlingen har en kvalitativ tilnærming. I delstudie I ble det gjort en review avartikler for å se på stress relatert til kropp, rom og relasjon. I delstudie II ble det gjennomført intervju medtidligere intensivpasienter om opplevelsen av kropp, kraft og bevegelse under kritisk sykdom. I delstudie III bletidligere intensivpasienter intervjuet angående deres opplevelse av kroppsnærværet til pårørende under kritisksykdom. I delstudie IV ble det gjort observasjoner med påfølgende intervjuer av intensivsykepleiere om deresformidling av erfart og fortolket kunnskap i en klinisk veiledningssituasjon. I alle fire delstudiene benyttes detfenomenologisk-hermeneutiske analyser. Funn: I delstudie I kommer det fram at pasientene opplever stress knyttet til kropp, rom og relasjon.Kroppen påvirkes gjennom søvnavbrudd, smerter, angst og pasientene mister kontrollen over kropp og situasjon.Stress knyttet til rom framkommer gjennom at rommet blir et speil av situasjonen ved at den både representererlivet, men også redselen for døden. Gjennom det horisontale leie opplever pasientene at situasjonen utgjør enform for makt og de selv settes i avmakt. Relasjonelt stress framkommer oftest knyttet til sammenhenger hvordet utføres observasjoner, stell og behandling. Travelhet og organisering i avdelingen påvirker det relasjonellesamværet i form av stress. I delstudie II opplever intensivpasientene at kropp kraft og bevegelse trer fram bådegjennom ”tapet” av kroppen, hvordan de handterer situasjonen og hvordan de gjenerobrer kropp, kraft ogbevegelse. De opplever kraftløshet og bevegelsesbergrensninger. Dette innvirker på avhengigheten til andre ogskaper konflikter til pårørende. Pasientene handterer det kroppslige tapet gjennom mobilisering av familiengjennom å involvere dem. Samtidig blir de selvbeskyttende og utestenger familiesammenhengene. Kampen forlivet håndterer de gjennom galgenhumoren og skriket om hjelp som siste nødrop. Gjenerobringen av kroppen erknyttet til små framskritt, gjennom personalets motivasjon og gjennom drømmen om å utrette noe i livet. Idelstudie III opplever pasientene konflikt mellom nærheten og distanse til pårørende. De kjenner seg utestengt,samtidig som de bekreftes med gaver. Pasientene opplever det konfliktfylt når de sammenligner pårørendesreaksjoner og egen situasjon. De er redd at fellesskapet med pårørende skal opphøre, samtidig må de begrensesamværet. Å ikke kunne kommunisere med pårørende i kroppsnærværet oppleves motsetningsfullt. I delstudieIV formidler sykepleierne kunnskap til intensivstudentene gjennom meningsskapende kunnskapsbevegelser. Deformidler inntrykk fra situasjonen for å skape oversikt, de formidler kunnskap om fenomenene som framtrer ogde formidler hvordan de kan hjelpe kroppens egne prosesser. De vurderer og formidler også pasienteneskroppslige uttrykk og hvordan disse kan forstås og imøtekommes. Sykepleierne er også opptatt å formidlekunnskap for at studentene skal utvikle og få egne erfaringer i kroppen. Konklusjon: Gjennom fire delstudier løfter avhandlingen fram kunnskap som står i klar kontrast til dennaturvitenskapelige kunnskapen. Pasientene utsettes for store opplevelsesmessige belastninger i situasjonen somakutt/kritisk syke som setter de i en avmaktssituasjon ved at sykepleierne ikke fanger opp og handterer kroppensegen kunnskap i situasjonen. Pasientene befinner seg ofte i en eksistensiell situasjon som er preget avmarginalitet og eksistensiell væren. Pasientene viser at de har forutsetninger for å mestre situasjonen, menhjelpes lite til slik mestring. Intensivsykepleierne formidler ulikt faglig innhold til studentene for å skapeerfaringer og forståelse i situasjonen. Erfaringskunnskapen fra intensivkonteksten må derfor sees som et viktigkunnskapssupplement til folkehelsearbeidet. / Background and purpose: Acute/critically ill patients have had their life-conditions severely altered from awell-functioning everyday situation to a situation in which they struggle to survive. Traditionally the knowledgeparadigmfrom natural sciences together with medical expertise constitutes the framework for treatment. To beacute/critically ill involves experiences and events and phenomena typical to the situation. The patients’embodied knowledge is not limited to the personal and private sphere, it refers to highly relevant preconditionsfor visibility and reception, also on an existential level; it represents knowledge which needs to be researchedand discussed openly within the public health and nursing sciences. This knowledge represents a differentontology and epistemology from the natural sciences and thus a different perspective, also with regards toclinical tutoring. The dissertation’s primary target is to increase the knowledge about how critical illness isexperienced and how experience based knowledge is significant to teaching in an intensive care context. Data and methods: The dissertation is based on qualitative methods. Sub-study I includes reviews ofarticles on stress in a perspective of body, space and relationship. Sub-study II contains interviews with formerICU patients relating to their experience of body, strength and movement during critical illness. Sub-study III isbased on former ICU patients’ experience of the physical presence of their significant others during criticalillness. Sub-study IV contains observations and interviews of ICU nurses on how they teach experience basedand interpretation based knowledge in clinical tutoring. Phenomenological-hermeneutic analysis method isapplied to all four sub-studies. Findings: Sub-study I describes how patients experience stress in a perspective of body, space andrelation. The body is influenced by sleep deprivation, pain and anxiety. Patients experience loss of control withtheir bodies as well as with the situation. The room mirrors the situation patients are in, creating stress by itsrepresentation of life as well as fear of dying. The patient’s horizontal position reflects disproportionate powerinducing a sense of disempowerment. Relational stress situations usually appear in contexts involvingobservation, care or treatment. The organizational structure and activity on the ward affects stress levels. In substudyII the ICU patients experience how power and movement is affected by a sense of loss of body, how theymanage to respond to the situation and how they eventually reclaim the body, power and movement. Theyexperience disempowerment and limitations to movement. This causes dependency and creates conflicts withtheir significant others, especially with regards to proximity and distance. The patients address their loss of bodyby drawing on resources from their significant others, yet refrain from allowing themselves involvement infamily matters. The struggle for survival is characterised by gallows humour and the cry for help as their finalcry. Reclaiming the body happens stepwise with the aid of staff combined with a need to achieve. Sub-study IIIdescribes problems related to proximity to, and distance from, the significant others. A sense of exclusion iscontradicted by being showered with gifts. It is unsettling for patients to have their situation compared to theirsignificant others’. They fear the loss of community with loved ones, yet they need to limit visits fromsignificant others. The lack of ability to communicate when others are physically present is unsettling. Sub-studyIV describes how ICU nurses tutor students in practise by demonstrating knowledge in meaningful actions. Theyconvey their impressions of situations to provide an overview, convey knowledge of observable phenomena, andteach skills to assist the body’s own processes. They also assess and evaluate physical expressions in the patientand how these can be read and addressed. Nurses are also concerned with conveying embodied knowledge totheir students. Conclusion: In four sub-studies this dissertation highlights a form of knowledge which clearly contraststhat of the natural sciences. During acute critical illness patients experience severe stress and disempowermentcaused by a lack of response and action from nurses who are unable to interpret the body’s own knowledge inthe situation. Patients are often facing life and death questions characterised by marginality and existentiality.Patients demonstrate ability to cope with the situation, but are rarely assisted with coping. Intensive care nursesdisseminate a variety of professional skills and knowledge to their students in order to provide comprehensionand understanding of situations. Experience based knowledge from an intensive care context thus becomes asignificant supplementary factor in the public health perspective

No description available.

Summaries in Afrikaans and English / The aim was to establish factors related to learning motivation and learning attitude of learners in historically coloured schools. An eclectic approach was followed because theoretical views on motivation could not furnish a comprehensive theory. The definition emerging from this approach states that motivation is a process started within a person to create a state of need for satisfaction and happiness that can be reached by instigating and sustaining goal-directed activity. The link between learning and motivation, as well as related factors, was ascertained. Determinants of high and low levels of learning motivation were established. Programmes aimed at higher motivation levels were explored. Empirically it was proven that grade 9 learners in historically coloured schools leaned more towards an extrinsic orientation; grade 12's more intrinsic. An intervention programme is suggested. / Die doel was om vas te stel watter faktore hou verband met die leermotivering en leerhouding van leerders in histories bruin sekondere skole spesifiek. 'n Eklektiese benadering is gevolg omdat die teoretiese beskouings oor leerrnotivering nie 'n bevredigende allesomvattende teorie kon verskaf nie. Die werksdefinisie van motivering is 'n gevolg daarvan en lui as volg: motivering is die proses wat in die persoon aan die gang gesit word om 'n staat van behoefte na tevredenheid en geluk te skep wat bereik kan word deur doelgerigte aktiwiteit aan te stig en aan die gang te hou. Die verband tussen leer en motivering is bepaal asook die faktore wat verband hou met leermotivering. Bepalers van hoe en lae leermotiveringsvlakke is vasgestel en ingrypingsprogramme gemik op verhoogde motivering is ondersoek. Empiries is bewys dat die graad 9-leerders meer geneig is tot ekstrinsieke orienterings rakende leermotivering; graad 12-leerders meer intrinsiek. 'n lngrypingsprogram word voorgestel. / Teacher Education / M. Ed. (met spesialisering in Voorligting)

Summaries in Afrikaans and English / The aim was to establish factors related to learning motivation and learning attitude of learners in historically coloured schools. An eclectic approach was followed because theoretical views on motivation could not furnish a comprehensive theory. The definition emerging from this approach states that motivation is a process started within a person to create a state of need for satisfaction and happiness that can be reached by instigating and sustaining goal-directed activity. The link between learning and motivation, as well as related factors, was ascertained. Determinants of high and low levels of learning motivation were established. Programmes aimed at higher motivation levels were explored. Empirically it was proven that grade 9 learners in historically coloured schools leaned more towards an extrinsic orientation; grade 12's more intrinsic. An intervention programme is suggested. / Die doel was om vas te stel watter faktore hou verband met die leermotivering en leerhouding van leerders in histories bruin sekondere skole spesifiek. 'n Eklektiese benadering is gevolg omdat die teoretiese beskouings oor leerrnotivering nie 'n bevredigende allesomvattende teorie kon verskaf nie. Die werksdefinisie van motivering is 'n gevolg daarvan en lui as volg: motivering is die proses wat in die persoon aan die gang gesit word om 'n staat van behoefte na tevredenheid en geluk te skep wat bereik kan word deur doelgerigte aktiwiteit aan te stig en aan die gang te hou. Die verband tussen leer en motivering is bepaal asook die faktore wat verband hou met leermotivering. Bepalers van hoe en lae leermotiveringsvlakke is vasgestel en ingrypingsprogramme gemik op verhoogde motivering is ondersoek. Empiries is bewys dat die graad 9-leerders meer geneig is tot ekstrinsieke orienterings rakende leermotivering; graad 12-leerders meer intrinsiek. 'n lngrypingsprogram word voorgestel. / Teacher Education / M. Ed. (met spesialisering in Voorligting)

This research focused on the experiences of HIV disclosure to significant others amongst people living with HIV. The aim of the research was to explore how people living with HIV experience disclosure of their HIV positive status to their significant others. The social constructionist perspective was utilized to gain a deeper understanding of the experience of HIV positive status disclosure to significant others. The study’s sample comprised of five participants who were recruited using purposive sampling strategy. Data was collected with using face to face semi structured interviews. Themes were extracted and analysed using thematic content analysis. An analysis was made as to whom participants choose to disclose to, the reaction of the people they disclosed to, as well as their reasons for disclosing. Results were reported as the participants’ experiences and noted as is or unadulterated. / Psychology / M.A. (Psychology)