Bakgrund: Långvarig smärta påträffas hos uppskattningsvis hälften, 40-65 %, av Sveriges befolkning. Smärtan ska ha varit kvarstående i minst tre månader för att den ska kvalificeras som långvarig. För att behandling ska fungera är det av stor betydelse att personen med smärta ska bli lyssnad på och trodd i sin subjektiva upplevelse av smärta. Den långvariga smärtan påverkar det dagliga livet på ett negativt sätt. Den teoretiska utgångspunkt som har använts är Erikssons teori om lidande samt det vårdvetenskapliga konsensusbegreppet hälsa. Syfte: Syftet var att beskriva upplevelser av att leva med långvarig smärta. Metod: En litteraturöversikt gjordes där åtta vetenskapliga artiklar utgjorde grunden för resultatet i syfte att skapa en översikt på den aktuella befintliga forskningen. Resultat: I litteraturöversikten identifierades sex olika kategorier. Dessa var upplevelsen av förändringar i vardagen, upplevelsen av smärtan som oförutsägbar och en fiende, upplevelsen av förändrad självbild, upplevelsen av smärthantering och smärtlindringsstrategier, upplevelsen av vändpunkter och att se det positiva samt upplevelsen av mötet med vårdpersonal. Det framkom i resultatet att smärtan hade en negativ inverkan på livet ur fysiska, sociala samt psykiska perspektiv. Det visade sig att den långvariga smärtan påverkar det vardagliga livet med en negativ inverkan. När man blev tvungen att ändra på ens livsstil påverkades självbilden och känsla av värdighet negativt. Det visade sig dock att genom en positiv inställning till smärtan kunde personer/patienter lära sig att leva med den samtidigt som det fanns ett stort missnöje med vården främst på grund av upplevelsen att inte bli trodd eller lyssnad på. Diskussion: Metoddiskussionen tar upp fördelar och nackdelar med den valda metoden som diskuteras samt analyseras. I resultatdiskussion analyseras resultatet samt återkopplas till Erikssons teori om lidande samt diskuteras utifrån bakgrunden för denna litteraturöversikt och utifrån nya vetenskapliga artiklar. / Background: Long term pain is found in approximately half, 40-65 %, of the Swedish population. The pain must have been outstanding for at least three months for it to be classified as long term. For treatment to work, it is essential that the person with pain should be listened to and believed in their subjective experience of their pain. The long term pain influences the daily life in a negative way. The theoretical basis used is Erikson's theory about suffering andthecareof scientificconsensusconcept of health. Aim: The aim was to describe the experiences of living with long term pain. Method: A literature study was done where eight scientific papers formed the basis of the results in order to create an overview of the current existing research. Results: The literature review identified six different categories.These were the experience ofchangesin everyday life, the experience of painasunpredictable andan enemy, the experience of alteredself-image,the experience ofpain managementand pain managementstrategies, the experience of turning pointsandto see the positiveas well asthe experience ofmeeting withhealth professionals. Longterm pain hada negative impact onthe life out ofphysical, socialandpsychologicalperspective. It was shown thatchronic painaffectseveryday lifewitha negative impact.Whenthey were forcedto changeone's lifestyleinfluencedthe self-imageandsense of dignitynegative.It turned out, however, that through a positiveattitude towardpaincouldpeople/patientslearn to live with it while there was great dissatisfaction with the caremainly because ofthe experienceof not being believed or listened to. Discussions: The method discussion addresses the advantages and disadvantages of the method chosen are discussed and analyzed. In the discussion of results the result was analyzed and reconnected back to Erikson's theory of suffering and discussed based on the background for this literature review and based on new scientific articles.

Bakgrund; Många patienter inom palliativ vård lider av svår smärta. Ofta ger den farmakologiska behandlingen inte tillräklig smärtlindring vilket har lett till ett ökat intresse för komplementära smärtlindringsmetoder inom palliativ vård. Syfte; Att beskriva effekten av komplementära smärtlindringsmetoder inom palliativ vård. Metod; Studien genomfördes som en litteraturöversikt och baseras på tretton kvantitativa artiklar. Resultat; Massage, akupunktur och musikterapi har studerats då dessa behandlingar är godkända i Sverige. Artiklarna visar en signifikant smärtlindring efter behandlingarna men varaktigheten varierade mellan grupperna. Musikterapi och massage har främst en kortverkande effekt medan akupunktur har en långverkande effekt som kräver upprepade behandlingar. Slutsats; De komplementära behandlingarna vid sidan av farmakologisk behandling tyder på att patienterna får en bättre smärtlindring och livskvalitet. Behandlingarna är enkla att utföra och inga biverkningar påvisas. Samtliga komplementära behandlingar skulle därför kunna vara ett alternativ på palliativa enheter och inom hemsjukvården. / Background; Many patients within palliative care suffer from severe pain. Despite farmacological treatment some patients still experience insufficient pain relief. This has led to an increased interest in complementary therapies within palliative care. Aim; To describe the pain relieving effects of complementary therapies within palliative care. Method; This study is carried out as a literature review based on thirteen articles with quantitative approach. Results; Massage, music therapy and acupuncture has been studied as these treatments are accepted by Swedish law. The results showed a significant improvement of pain after the treatments. Duration of the  pain relieving effects varied between the different methods. Music therapy and massage showed an immidiate but short term effect. Acupuncture showed a long term effect that needed to be repeated for best effect. Conclusion; Complementary methods may together with farmacological treatment improve the pain relief and offer a better end of life.

In 1999, aged eighteen, I read 'The Brothers Karamazov' by Dostoevsky. I read this novel in Burundi, where I witnessed the suffering of others. The country's basic problem was civil war, which is best described in this terse note: "Rwanda, the sequel. Same story, different location. Nobody cares." The well-publicised problems in Rwanda in 1994 didn't end, they went next-door. The only thing separating the problems of those two countries was the most heavily landmined stretch of road on the planet. It was on this road, which was littered with the remains of vehicles and people, that I experienced the immediacy of 'the problem of evil'.I had hoped that the book I held in my hands on those lifetime-long hours on the road would resonate with my experience. Ivan Karamazov's accusation of the God who creates a world of atrocities seemed fuelled by an unflinching look at senseless, disteleological suffering. I had hoped that Ivan, with his face turned against God, could countenance the horror I saw. Karamazov's stance has been seen as the antithesis of theodicy, which is the attempt to reconcile faith in God with the existence of evil. This antithesis seems to overcome the distance between the experience of real suffering and the account of that suffering given by academic theodicy. Ultimately, however, that distance remains. Dostoevsky's protagonist in his railing against God connects no more with the victims in this world than a writer of theodicy does with her defence of God.

The objectives of this research were to investigate the lived experiences of parents who are suffering from the HIV/AIDS disease, investigate the lived experiences of children whose parents are suffering from the HIV/AIDS disease and propose an ecosystemic intervention programme for supporting children whose parents are suffering from the HIV/AIDS disease. The literature research investigation revealed that part of the burden that learners whose parents suffer from HIV/AIDS carry comes in the form of mental stress and experiences caused by, merely staying with a sick loved one whose condition deteriorates where hope of improvement was expected, prolonged sickness of a loved one, and witnessing the slow painful death of a loved one especially at home. These children often take on additional domestic tasks or care for sick relatives or younger siblings. The children's attendance can be compromised during this time. Their incentive to protect themselves against infection can be low when HIV is only one of many threats to health and life. Poverty may also breed low levels of respect for self and others, and thus a lack of incentive to value and protect lives. The mediating mechanisms act in ways which reduce the impact of risks, reduce negative chain reactions, maintain self-esteem and self-efficacy through relationships and task achievement and open opportunities for positive development. Findings from the empirical research reveal that parents who are HIV-positive are unemployable because of their ill-health, a situation which makes their families to leave in dire poverty. The parents often blame each other for their HIV-positive status sometimes as a way of relieving stress, but when these parents blame each other their children are caught in the cross-fire. Children of parents who suffer from HIV/AIDS are discriminated against and stigmatised by other children, friends and people from their communities. This situation affects these children both psychologically and emotionally. These children assume adult responsibilities at a very tender age, usually lack basic needs such as food, clothing, school uniform, school necessities etc. Their scholastic performance gets negatively affected because of lack concentration, not having enough time to do homework and being frequently absent from school. The children become vulnerable to verbal, emotional and physical abuse, do not get the necessary support they need from their family members, community, government institutions such as the Department of Health and in schools where they attend. These children do not seem to be coping with the circumstances they find themselves in especially if they are also HIV-positive. There is no communication between children of parents who suffer from HIV/AIDS and their parents concerning their experiences about the disease, how they feel and the future expectations. There is also no clear plan on what should these children do, in the case of their parents' death. At schools where these children attend there are no clear strategies to assist them to catch-up with their school work after a long absence and the children do not receive any work from school while they are at home sick or recuperating from illness as per the National Policy on HIV/AIDS. An ecosystemic programme is proposed in this research. / Thesis (M.Ed.)--North-West University, Vaal Triangle Campus, 2008.

The principal contention of this thesis is that the earliest Christians viewed the crucifixion of Jesus as paradigmatic for discipleship, confirmation of which can be found in the history and function of a particular saying ascribed to Jesus, namely the ‘cross saying’ (Mk 8:34 and par.). To verify this claim, I explore both the literary tradition and material culture of early Christianity as they relate to the cross saying, explicating the various ways that “taking up the cross” functioned to ensure unwavering loyalty to Jesus. Taking a traditional exegetical approach, I also engage recent work on sapiential literature (mainly Q) and Historical Jesus studies, observing the diverse ways in which the first several generations of Jesus’ followers adapted this saying—both as an aphorism for inclusion in gospels, and in the development of cognate versions useful in more theological settings (e.g., Gal 2:20). Proceeding diachronically via a textual analysis of the cross saying in Q, the Synoptics, and then the Gospel of Thomas, I trace the ways in which the composers of these texts addressed the different social situations of their audiences in an effort to secure commitment to Jesus (or, in the case of Gos. Thom., conformity to his enlightened teachings). Then, turning from the literature to the social and political environment of the New Testament, I note the radical reversal, occurring early in Christian thought, which transformed the crucifixion of Jesus from a shameful social experience into one of honour, and worthy of emulation. Even more significant in terms of current research, I break from the opinions of several New Testament scholars in finding little evidence that the cross saying (presuming it was dominical) functioned as a call to political insurrection. Rather, as evidenced in Christian material culture from the second and third centuries (symbols, the orant prayer posture, making the ‘sign of the cross,’ and so on), the association of crucifixion with discipleship was understood primarily in terms of religious devotion to Jesus.

This dissertation explores theologies of suffering through engagement with five theologians from across fifteen centuries of the Christian tradition: Gregory the Great, Julian of Norwich, Jeremy Taylor, C.S. Lewis and Ivone Gebara. It uses a typological method to examine the types of responses that are advocated by each theologian, and the relation of their responses to five theological touchstones: Humanity, Sin and Evil; God’s Providence; Salvation; Christ; and Eternal Life. The Introductory Chapter provides an exploration of the definitions and etymologies of suffering and grief; a description of the typological method; an examination of notable relevant literature; and an introduction to the five thinkers. Chapter One is an examination of the life and writings of the 6th century pope Gregory the Great, with particular focus on The Book of the Pastoral Rule and Moralia. Gregory understands suffering to be a discipline sent by God to the faithful. Chapter Two is an examination of the life and Revelations text of the 13th century English mystic Julian of Norwich, who focuses on the reward God desires to give those who suffer. Chapter Three is an examination of the life and writings of 17th century Anglican bishop Jeremy Taylor, with particular focus on Holy Living and Holy Dying. Taylor places an emphasis on the lifelong practice of faithfulness in preparation for death. Chapter Four is an examination of the life and writings of 20th century Anglican theologian and author C. S. Lewis, with particular attention to The Problem of Pain, The Chronicles of Narnia, A Grief Observed, and Letters to Malcom. Lewis offers the example of one who is willing to engage with the depth of his grief and to question God on his road to acceptance. Chapter Five is an examination of the life and writings of contemporary Brazilian, feminist and liberation theologian Ivone Gebara, with particular focus on her book Out of the Depths and her engagement with Latin American author Isabel Allende. Gebara questions traditional understandings of suffering, as well as when suffering is to be accepted and when suffering is unjust and should be combated. The Concluding Chapter constructs a contemporary theology of suffering drawing on the insights and wrestling with the challenges raised by the varying perspectives of the five theologians. The goal is to provide a hopeful and nuanced way of thinking theologically about suffering for contemporary Christians. The contemporary theology affirms the importance of the call, found in Gebara, to combat unjust suffering through acts of love and mercy, while also affirming that acceptance of the reality of endemic suffering, found in all five theologians, can provide one with opportunities to grow spiritually, live more faithfully and to experience the blessings in the midst of suffering that are a foretaste of heavenly bliss.

Bakgrund: ECT har funnits inom den psykiatriska vården sedan 40-talet och används fortfarande idag. Behandlingen är vanligast hos patienter med djup depression. Trots att behandlingen är vanlig finns det en begränsad kunskap om patienters erfarenheter inom området.  Sjuksköterskorna ansvarar för omvårdnad och ska identifiera patienternas behov.  Syfte: Syftet är att beskriva erfarenheter av ECT hos patienter som lever med depression. Metod: En kvalitativ innehållsanalys av 12 narrativa texter i form av bloggar har lyfts fram. Resultat: En hoppfullhet finns inför behandlingen, men patienterna är rädda för att biverkningar efteråt ska påverka deras liv negativt. ECT hjälper patienterna att bryta depression, men biverkningar i form av minnesstörningar och kognitiv påverkan förekommer. Patienterna anser att delaktigheten blir lidande då informationen för att kunna ta ett beslut om ECT är bristfällig. Konklusion: Patienterna ser en ljusare framtid då ECT har hjälpt dem att bryta depressionen och lidandet. Patienterna önskar att informationen om ECT:s  risker och biverkningar skulle ha lyfts fram tydligare då biverkningarna påverkar deras liv negativt så som minnesstörningar och kognitiv biverkan. Det är viktigt att sjuksköterskorna samspelar med patienten och gör patienten delaktig i den egna vården för att minska lidandet. / Background: ECT has been a part of psychiatric health care since the 1940’s and is still used today. The treatment is most commonly used with patients suffering from deep depression. Despite the treatment being common, there is little knowledge of the patients’ experiences thereof. The nurses are responsible for the nursing of the patient and for identifying the patients’ needs. Aim: The aim of the study is to describe the experiences of ECT for patients suffering from depression. Method: The study applies a qualitative content analysis in 12 narratives from blogs. Results: Patients are hopeful before the treatment, but at the same time anxious that the treatment will have side effects affecting their lives. ECT helps patients defeat depression, thus sideeffects such as memory disorders and cognitive loss may occur. The patients experience losses in involvement as the information needed to make a decision on ECT is flawed. Conclusion: Patients see a brighter future as ECT has helped them to defeat their depression and suffering. The patients wish that they had been given clearer information regarding the risks and side effects of ECT as the side effects affected their lives. It is therefore important that the nurses cooperate with the patients in order to support their needs and reduce suffering.

Bakgrund: Bröstcancer är den vanligaste cancerformen hos kvinnor i Sverige. Diagnosen kan vara ett svårt besked som medför oro. Sjukdomen kan behandlas med kirurgi där bitar av eller hela bröstet tas bort eller med cytostatika. Sjuksköterskans omvårdnadsuppgift är att se personen med sjukdomen för att främja hälsa och välbefinnande samt att minska lidande. Hopp är viktigt för att uppleva livskvalité och sjukdomen kan präglas av såväl fysiska som emotionella faser, där upplevelsen av en förändrad identitet uppenbaras. Metod: En kvalitativ metod av narrativer ligger till grund för studien och analysprocessen. Syfte: Att beskriva kvinnors upplevelser av att leva med bröstcancer. Resultat: Tre teman och sex subteman speglar resultatet. (1) Behov i en tid av oro; innefattar upplevelser av stöd och trygghet samt hantering av känslor. (2) En förändrad självbild; innefattar upplevelser av kroppsliga förändringar, vård och behandling. (3) Osäkerhet relaterad till ovisshet; innefattar existentiella tankar samt kvinnornas oro och rädsla. De teman som framkommer stödjer varandra och tillsammans visar de upplevelser av hur det är att leva med bröstcancer. Konklusion: En inblick i upplevelserna kan ge sjuksköterskor möjlighet att identifiera och bemöta kvinnornas varierande behov. / Background: One of the most common cancers among women in Sweden is breast cancer. The diagnos can be a hard message which can bring worries. It can be treated with surgery were the whole breast or peace’s of the breast is removed or with cytostatic. The nursing role is to see the person with the disease in order to promote health and well-being and to minimize the suffering. Hope is important to experience quality of life and the disease can be influenced by physical and emotional phases where a changed identity is experienced. Method: A qualitative method of narratives is used in the study and analysis. Aim: To describe womens experiences of living with breast cancer. Result: Three themes and six suthemes is shown. (1) Needs in a time of worries; comprises support and safety, managing the different emotionals. (2) A changed self-image; comprises the experiences of physical changes, care and treatment. (3) Uncertainty related to incertitude; existential thoughts, womens fears and worries. The themes are supporting each other and together they shows experiences of living with breast cancer. Conclusion: An insight in the experiences can give nurses an opportunity to identify and respond to womens different needs.

Bakgrund: Kroniska sår innefattas av bensår, fotsår, trycksår, diabetessår, sårskada, tumörer, reumatiska sår och vårdskador vid komplikationer efter kirurgiska ingrepp, som inte har läkt inom 6 veckor. Forskning visar att trots att förebyggande strategier används, utvecklas det sår som kräver behandling. I mötet med vården är en god omvårdnad och en god vårdrelation viktig. Bristen på dessa leder ofta till ett lidande som individen måste kämpa emot med copingstrategier. Syfte: Syftet med denna litteraturstudie var att belysa personers erfarenhet av att leva med kroniska sår. Metod: En litteraturöversikt gjordes i denna studie med 15 vetenskapliga artiklar, som bestod av både kvantitativ och kvalitativ metod. Resultat: 3 huvudkategorier identifierades: begränsningar, lidande samt coping. Deltagarna ansåg att en brist på information samt begränsningar i vardagen påverkade individens sociala umgänge och fysiska aktivitet. Smärta, skam och rädsla ledde till depression. För att hantera detta använde individerna sig av familjen och stöd av vårdpersonalen Slutsats: Det framkom att individernas dagliga liv påverkades av det kroniska såret. Den konstanta smärtan orsakade sömnsvårigheter hos individen, vilket ytterligare försvårade hanteringen av smärtan och vardagen. Kontinuitet hos vårdpersonal och i behandlingen gav personerna en trygghet och en ökad förståelse för sitt tillstånd. Det belystes att det var viktigt att vårdpersonalen ser individen bakom såret, och inte bara lägger sitt fokus på sårläkningen och behandlingen. / Bakground: Chronic wound comprises of leg ulcer, foot ulcer, decubitus, diabetic ulcer, damaged ulcer, tumors, rheumatic wounds and care damage with complications after surgical intervention, which hasn't healed within six weeks. Research gives the results of showing that, even though prevention of strategies are used, the ulcer is still developing and needs treatment. In the meeting with the healthcare, it is important to have a good nursing and a good relationship care. Lack of this often leads to suffering that the individual must endure with the aid of coping strategies. Aim: The aim of this study was to explore the persons experience of living with a chronic ulcer. Method: In this study a literature review was done, with 15 scientific articles, which consisted of both quantitative and qualitative methods. Results: 3 main categories where identified: restriction, pain and coping. The participants felt that it was lack of information and limitations in everyday life which affected the individual's social life and physical activity. Pain, shame and fear led to depression. To get the capability to handle the situation, the individuals turned to their families and care provider for support. Conclusion: As it is stated, the individuals where affected in their everyday life due to the chronic ulcer. The constant pain which is caused the sleeping disturbances in the individual´s made coping the pain and everyday life harder. Continuity with the healthcare provider and treatment gave an understanding and safety for the individuals for their condition. It was important that the health professionals not only put their focus on the healing of the wound and the treatment, they must also put attention to the individual with the wound.

I Sverige och globalt har det de senaste decennierna rapporterats en ökning av icke suicidalt självskadebeteende. Icke suicidalt självskadebeteende har definierats som skada en person medvetet tillfogar sin kropp. Forskning inom området har visat på att personer med icke suicidalt självskadebeteende känt sig stigmatiserade och upplevt dåligt bemötande inom vården. Syftet i denna studie var att beskriva hur det är att leva med icke suicidalt självskadebeteende (NSSI), genom att studera bloggar. En kvalitativ innehållsanalys på sex bloggar gjordes. En induktiv ansats användes för att fånga olika perspektiv angående hur det är att leva med NSSI. Analysen av innehållet resulterade i två kategorier som genomgående kunde återfinnas i alla studerade bloggar. En evig kamp med subkategorierna Att leva med ett beroende, Att sluta skada sig, Att känna sig utanför och Att dömas av vården, Att finna hopp och mening med subkategorierna Att känna stöd från andra och Att ha framtidstro. Personer med NSSI upplever ofta stigmatisering från samhället, vilket skapar lidande. Genom att, som sjuksköterska, möta dessa personer där de befinner sig i sitt lidande kan en trygg och respektfull relation skapas med vårdsökande person. / The recent decades, the number of Non-suicidal Self-injury (NSSI), has increased in Sweden and globally. NSSI has been defined as a conscious self-inflicted physical injury. Research within this field has shown that individuals with NSSI have been stigmatised and has received poor treatment by the healthcare. The purpose with this study is to describe what it is like to live with Non-Suicidal Self-Injury (NSSI) through the study of blogs. Qualitative content analysis of six blogs has been done, and an inductive approach was chosen to capture different perspectives of what it is like living with NSSI. The analysis of the content resulted in two categories that could consistently be found in all the studied blogs. An eternal struggle with the subcategories To live with addiction, To end self-harming, To feel left out, and To be judged by the care system, To find hope and meaning with the subcategories, To feel support from others and To have hope for the future. Individuals with NSSI often experience stigmatisation from the society, which causes further suffering. As a nurse, by meeting these care seekers at where they are in their suffering could help to create a safe and respectful relationship.