Many patient-level barriers to more effective post-fracture osteoporosis (OP) management are associated with patients’ perceptions of their bone health and the link between their fracture and OP. These barriers could be addressed by interventions which account for the role of patients’ perceptions, such as those based on theories of behaviour change. This thesis had two objectives: to review the literature and determine whether these theories have been integrated in post-fracture OP management and to examine patients’ awareness of the OP-fracture link. The results showed that theories of behaviour change have not been integrated into post-fracture interventions, that most patients do not perceive the OP-fracture link even after a baseline intervention and that two baseline factors predict who is less likely to make the OP-fracture link at follow up. Based on these findings, modifications to current OP interventions were proposed and guidance that could help create new, patient-centered interventions was provided.

Many patient-level barriers to more effective post-fracture osteoporosis (OP) management are associated with patients’ perceptions of their bone health and the link between their fracture and OP. These barriers could be addressed by interventions which account for the role of patients’ perceptions, such as those based on theories of behaviour change. This thesis had two objectives: to review the literature and determine whether these theories have been integrated in post-fracture OP management and to examine patients’ awareness of the OP-fracture link. The results showed that theories of behaviour change have not been integrated into post-fracture interventions, that most patients do not perceive the OP-fracture link even after a baseline intervention and that two baseline factors predict who is less likely to make the OP-fracture link at follow up. Based on these findings, modifications to current OP interventions were proposed and guidance that could help create new, patient-centered interventions was provided.

Bakgrund: Varje år insjuknar ungefär 7000 personer i bröstcancer i Sverige, vilket innebär att 15-20 kvinnor om dagen får en bröstcancerdiagnos och att var tionde kvinna utvecklar bröstcancer under sin livstid. Mötena mellan dessa kvinnor och sjuksköterskan blir viktiga för upplevelsen av hela sjukdomsförloppet. Syfte: Syftet var att belysa hur kvinnor som lever med bröstcancer upplever mötet med sjuksköterskan. Metod: Studien var en allmän litteraturstudie som baserades på ett systematiskt urval av vetenskapliga artiklar, där elva artiklar har kvalitetsgranskats och analyserat. Resultat: Resultatet visade att bröstcancerdrabbade kvinnor upplevde trygghet, stöd och att de blev sedda, vilket kategoriserades som vårdande möten. De kunde även uppleva otrygghet, bristande stöd samt att de inte blev sedda. Detta benämndes icke-vårdande möten. Diskussion: Vikten av reflektion i det dagliga arbetet för att få till de vårdande mötena med patienten diskuterades. Även vikten av att tydliggöra sjuksköterskans ansvarsområden i utbildningen lyftes fram. Slutsats: Det finns ett fortsatt behov av att sprida kunskapen om kvinnors upplevelser av mötet med sjuksköterskan. Den förståelse för patientens situation som studien ger bör appliceras på alla patienter oavsett sjukdom, vilket kan leda till vårdande möten i alla vårdsituationer. / Background: Each year approximately 7000 people is diagnosed with breast cancer in Sweden, which means that 15-20 women a day get a breast cancer diagnosis and that one out of ten women develop breast cancer during their lifetime. The meetings between these women and the nurse will be important for the experience of the entire course of the disease. Aim: The aim was to highlight how women with breast cancer experience the meeting with the nurse. Method: The study was a literature review that was based on a systematic selection of scholarly articles, in which eleven articles have been quality reviewed and analyzed. Results: The results showed that women with breast cancer experienced security, support and being seen, which was categorized as caring encounters. The women also experienced insecurity, not being supported and not being seen. This was categorized as uncaring encounters. Discussion: The importance of reflection on a daily basis to get to the caring encounters with the patient was discussed. The importance of clarifying the responsibilities of the nurse in the education was also highlighted. Conclusion: There is a further need to raise awareness of women's experiences of the meeting with the nurse. The understanding of the patient's situation that this study gives should be applied to all patients regardless of disease, which can lead to caring encounters in all care settings.

Bakgrund: Idag beräknas minst 40 miljoner människor leva med den kroniska sjukdomen HIV. När HIV blev känt under 80-talet ansåg många att det endast var homosexuella eller personer som levde ett promiskuöst liv som smittades vilket gjorde att de smittade behandlades illa och frystes ut från samhället. Kunskapen inom området har ökat sedan dess, dock lever stigmatiseringen i samhället och inom vården kvar. Syfte: Att belysa hur personer med HIV upplever stigmatisering. Metod: Studien som gjorts är en allmän litteraturstudie baserad på 15 vetenskapliga artiklar. Resultat: Artiklarna analyserades och det framkom att personer med HIV upplever stigmatisering på flera sätt. Resultatet delades in i tre kategorier: Oro och rädsla inför att bli utsatt för stigmatisering, Diskriminering, utanförskap och befrielse samt Strategier för att kunna hantera stigmatiseringen. Diskussion: Stigmatisering i vårdrelaterade situationer leder till lidande hos personer som är HIV-smittade. Stigman bidrar även till att personerna med HIV får en djupare insikt i vad som är betydelsefullt i livet. Som sjuksköterska är det viktigt att känna till hur stigman inom vården upplevs samt vilka positiva effekter den kan ge, för att kunna utföra optimal omvårdnad. / Background: Today an estimated 40 million people are living with the chronic disease HIV. When HIV became known in the 80’s people thought that it was only homosexuals or people who lived a promiscuous lifestyle that were at risk of infection. As a result the infected were treated badly and became outcasts of society. Knowledge in this area has increased since then, however stigma in the community and in health care still remains. Aim: To illuminate how persons with HIV experience stigma. Method: The study is based on 15 qualitative, scientific articles. Results: The articles were analyzed and it was found that persons with HIV experience stigma in many ways. The findings resulted in three categories: Fear and anxiety about being exposed to stigma, Discrimination, exclusion and exemption and Strategies for managing stigma. Discussion: Stigma in health-related situations leads to suffering among persons with HIV infection. Stigma also makes them get a deeper insight into what is important in life. As a nurse it is important to know how people perceive stigma in health care, and that there might be a beneficial effect, in order to perform optimal care.

Children’s risk for overweight and obesity is particularly high in rural areas of the United States. Many health, psychosocial, and economic consequences are associated with childhood overweight and obesity, which concerns health researchers and professionals. But how and why might rural children be more at risk for being overweight and obese? This dissertation investigates childhood overweight and obesity in rural settings through three separate studies. First, a systematic literature review was conducted to identify determinants and mechanisms of childhood obesity-related behaviors that are specific to rural locations. The findings from the review show that lack of health resources and poverty within the rural environment may impact children’s social environment and individual factors. However, results are inconclusive and there continues to be a lack of studies focusing on linking environmental influence with individual factors. Second, a meta-analysis of current research evidence was conducted to assess the efficacy of rural interventions designed to reduce childhood overweight and obesity. Results showed that interventions have been efficacious yet modest, with a mean effect size of 0.18. Moderating variables were also examined. Mean intervention effect size was moderated by children’s age and intervention duration. Last, secondary data were used to examine the association between rural food stores and availability and affordability of fresh fruits and vegetables. A multilevel analytical approach was used to determine if rural location was associated with availability and affordability of fresh fruits and vegetables. After controlling for other variables, results showed that rural location was not associated with fruit and vegetable availability and affordability. The findings from this dissertation suggest that the area of rural childhood overweight and obesity remains understudied. More research is needed in order to understand the mechanisms of social ecological influences on diet, physical activity, and childhood overweight and obesity. This area of research, however, is rife with opportunities for public health education and promotion. Public health educators can help promote and advocate for environmental conditions that support healthy lifestyles.

Bakgrund: Nightingales idé om vårdande som ett kall för kvinnor är en milstolpe inom sjuksköterskeprofessionen. Innan Nightingale hade män haft en betydande roll i vården men idag representerar manliga sjuksköterskor enbart cirka 10 procent av sjuksköterskorna i Sverige. Eriksson beskriver att människan i grunden är en vårdare samt vikten av den vårdande relationen. Det finns dock upplevelser hos patienter att manliga sjuksköterskor inte lämpar sig att vårda och de föredrar vård från en kvinnlig sjuksköterska. Connells teori om att maskulinitet är kopplat till den manliga kroppen genererar en bild av mannen som stark, känslokall och aggressiv. Syfte: Att beskriva manliga sjuksköterskors upplevelser av att vårda. Metod: Allmän litteraturöversikt av tio vetenskapliga artiklar. Resultat: Tre teman skapades; Förhållningssätt i vårdandet, beröring och intimvård samt manlighet och vårdande. Manliga sjuksköterskor behövde ofta utveckla speciella strategier för exempelvis etablerande av en vårdande relation. Den vårdande relationen och vårdandet upplevdes besvärligt för manliga sjuksköterskor och därför betonades vikten av att vara anpassningsbar. Beröring beskrevs som känsligt och många beskrev vikten av försiktighet för att undvika missförstånd. Slutsats: Manliga sjuksköterskor behöver vara försiktiga och anpassa sig både vid vårdande av manliga och kvinnliga patienter. Manliga sjuksköterskor behöver i större utsträckning än kvinnliga sjuksköterskor tänka efter före handlande. / Background: Nightingale’s idea of caring as a call for women is a milestone in the nursing profession. Men had before Nightingale had a significant role in caring but today male nurses only represent approximately 10 percent of registered nurses in Sweden. Eriksson describes in her theory that fundamentally man is a caregiver and the importance of a caring relationship. However there are experiences among patients that male nurses are not suitable for caring and that they prefer care from a female nurse. Connells theory about masculinity as connected to the male body generates an image of the man as strong, insensitive and aggressive. Aim: To describe male nurses’ experiences of caring. Method: A descriptive literature review drawn from 10 qualitative research articles. Results: Three themes emerged through the analysis; Attitude of caring, touching and intimate care and masculinity and caring. Male nurses often had to develop special strategies for example in establishing a caring relationship. The caring relationship and caring could be difficult for male nurses and the importance of being adaptable was therefore emphasized. Touching was described as delicate and many described the importance of being careful to avoid misunderstandings. Conclusion: Male nurses need to be careful and able to adapt both in caring for male and female patients. Male nurses have to think before they take action to a greater extent than female nurses.

The purpose of this thesis is to provide taxonomy of risk management (RM) in new product development (NPD) research and, based on that, to develop a research agenda for this field of study. The review was based on a systematic review which not only concentrates peer reviewed journal papers but also conferences and a book chapter. A total of 58 academic sources have been retrieved published within the period of 1980-2012 and were classified into various purposeful themes. The review reveals that research on RM in NPD is mostly theoretical in nature and lacks empirical foundations. It also argues that while there has been written a lot on how risk should be managed in NPD process (prescriptive type), the other aspect of how risk is being managed (descriptive type) is not very well addressed. Based on this, various research gaps are identified from different developed themes. The review is limited in several ways. First, research cannot be regarded as complete or comprehensive literature review in the field of RM in NPD, although every effort has been made to include the articles relevant to review question. The themes selected for classification of articles could have been structured in many different ways. The research accomplishes an identified need for exhaustive classification of literature. It identifies discrepancies among theoretical and empirical knowledge and thus tries to bridge a gap between both types of knowledge.

Bakgrund: När omvårdnadspersonal möter patienter som är immigranter med ett annat modersmål så räcker inte språkkunskaperna alltid till. Syfte: Syftet var att beskriva omvårdnadspersonals upplevelser av att kommunicera med patienter som är immigranter med annat modersmål. Metod: En litteraturstudie baserad på tio vetenskapliga artiklar genomfördes. Artiklarna granskades utifrån Röda Korsets Högskolas granskningsmall. Resultat: Utifrån det givna innehållet så sammanställdes resultaten under tre kategorier: Språkbarriären som hinder för vård, här uppmärksammas att ”språkbarriären” som uppstår i kommunikationen mellan omvårdnadspersonalen och patientkategorin immigranter, är ett hinder i vården. Språkbarriären som stressfaktor, häri betonas att språkbarriären kan ses som en stresskälla för omvårdnadspersonalen. Språkbarriären som kräver tillfälliga tolkar: ett behov och ett hinder, här presenteras de så kallade tillfälliga tolkarna, d.v.s. tvåspråkiga anställda eller patienternas anhöriga, detta kan både uppfattas som ett behov och hinder i kommunikationen. Slutsats: Socialstyrelsen betonar att vårdpersonal ska ge alla patienter bra vård och omsorg oavsett patientens modersmål. Strategierna för att bekämpa språkbarriärer bör vara specifika för olika yrkeskategorier. Behovet att anlita utbildade tolkar för att säkerställa en tillfredsställande kommunikation mellan vårdpersonal och immigranter är viktigt. För att bekämpa språkbarriärer krävs insatserna från forskare, beslutsfattare och vårdpersonal. / Background: When health care staff interact with immigrant patients who have a different native tongue language skills are sometimes not sufficient. Aim: The aim is to describe the employees’ experiences when communicating with patients with a foreign native tongue. Method: A literature review was carried out based on ten scientific articles. These articles were reviewed with a review model used by the Red Cross Collage. Result: Based on the given context the results were compiled into three categories: Language barrier as an obstacle for health care, here attention is drawn to the fact that a ”language barrier”, which occurs between employees and immigrant patients, is an obstacle in health care. Language barrier as a stress factor, emphasizes that the language barrier can create stress for the staff. Language barrier which requires temporary interpreters: a need and an obstacle, temporary interpreters are presented here, namely bilingual employees or patients’ relatives. This is perceived as a necessity and an obstacle when communicating. Conclusion: The Swedish National Board of Health and Welfare emphasizes that the healthcare staff shall give all patients good health and social care no matter the native language. The strategies to combat language barriers should be specific for different professionals. The need to use trained interpreters, in order to assure a satisfactory communication between personnel and patients, is important.  To fight the language barriers actions from researchers, decision-makers and healthcare staff are required.

Bakgrund: I Sverige har 325 000 människor diagnosen typ 2-diabetes. Sjukdomen ställer stora krav på individen. För att sjuksköterskan ska ge en god omvårdnad behövs kunskaper om patientens individuella behov av stöd. Syfte: Syftet var att beskriva patienters upplevelser av sjuksköterskans stöd vid typ 2-diabetes. Metod: Studien genomfördes som en allmän litteraturstudie där nio vetenskapliga artiklar kvalitetsgranskades och analyserades. Resultat: Patienters upplevelser av sjuksköterskans stöd kategoriserades som emotionellt, informativt och värderande stöd. Viktiga faktorer i sjuksköterskans stöd var gemensamt engagemang, tillit, lindring av bördan, att bli sedd som en individ, kunskap genom information, dialog, kontroll och bekräftelse. Diskussion: Två faktorer diskuterades som påverkade upplevelsen av sjuksköterskans stöd. Hur sjuksköterskan gjorde patienterna delaktiga och tillgodosåg patientens individuella behov ansågs vara väsentligt. Slutsats: Det finns ett behov av att belysa hur patienter upplever sjuksköterskans stöd. Genom att sjuksköterskan har insikt i vad ett gott stöd innebär kan patienten få redskap till sjukdomshantering och ett förbättrat välmående. / Background: In Sweden, 325 000 people have the diagnoses of type 2-diabetes. The disease makes great demands on the individual. The nurse needs knowledge about the patient´s individual needs of support to give good nursing care. Aim: The aim was to describe the patients’ experiences of nurse-support in type 2-diabetes. Method: The study was conducted as a literature review and based upon nine scientific articles that were quality assessed and analyzed. Results: The patients’ experiences of nurse-support were categorized as emotional, informational and evaluative support. Important factors given about the nurse´s support was participation by both nurse and patient, trust, easing the burden, to be seen as an individual, knowledge through information, dialogue, control and acknowledgment. Discussion: Two factors were discussed that affected the patients’ experiences of nurse-support. How the nurse included the patients’ in the recovery and management of their disease and catered to the patient´s individual needs that were considered to be essential. Conclusion: There is a need to highlight how the patients’ experience the nurse's given support. Insight from the nurse into what good support means to the patient can improve disease management and well-being.

Bakgrund: Livet förändras för individer som drabbats av en brännskada. Många får beståendeärr och funktionsnedsättning som innebär stora sociala, fysiska och psykiska utmaningar sompåverkar deras liv. Brännskada är ett trauma som uppstår när huden kommer i kontakt medvärme. Huden fungerar som skydd för inre organ, reglerar kroppstemperatur ochvätskemängd, fungerar som känsel och kontaktyta samt infektionsbarriär.Syfte: Syftet var att belysa individers upplevelser av livet efter en brännskada.Metod: En allmän litteraturstudie genomfördes baserad på kvalitativa och kvantitativavetenskapliga artiklar.Resultat: Resultatet visade att individer som drabbats av en brännskada upplevde sin kroppsom främmande och kände sig begränsad i vardagen på grund av funktionsnedsättning ochsynliga ärr. Stödet från närstående var ovärderligt för dessa personer och det hjälpte demgenom den långa rehabiliteringen. Upplevelsen av meningsfullhet var mycket viktigt och detfann individerna genom att ha ett meningsfullt arbete och bli accepterade av samhället.Konklusion: Det sociala nätverket har stor betydelse för individens förmåga att hanteraföljderna efter en brännskada och påverkar även individens psykiska tillstånd. Därför är det avvikt att involvera hela familjen i omvårdnaden. / Background: Life changes for individuals affected by a burn. Many suffer permanent scarsand disabilities with high levels of social, physical and mental challenges that affect theirlives. Burn injury is a trauma that occurs when skin comes into contact with heat. The skinserves as protection for internal organs, regulates body temperature and fluid volume, acts asa touch and contact area and infection barrier.Purpose: The aim was to highlight individual’s experiences of life after a burn injury.Method: A general literature review was conducted based on qualitative and quantitativescientific articles.Results: The results showed that individuals who suffered a burn injury experienced his/herbody as foreign and felt restricted in everyday life because of disabilities, and visible scars.The support from relatives was invaluable for these individuals and it helped them through thelong rehabilitation. The experience of meaningfulness was very important and the individual’sfound it by having meaningful work and be accepted by society.Conclusion: The social network is of great importance for the individual’s ability to deal withthe consequences after a burn injury and also affects the individual’s mental state. Therefore,it is important to involve the whole family in nursing.