No description available.

No description available.

No description available.

The purpose of this study is to explore care in Ontario, Canada from the perspective of patients. I took on the roles of both a patient and a researcher, exploring the current state of care as a patient who has navigated the health system and as a researcher with background in disability studies and social geography. I use feminist auto/ethnographic methods, including observation and fieldnotes, journaling, memory, and notes in my patient records as data. I also conducted semi-structured in-depth interviews with seven individuals who underwent hip or knee replacement surgery and two family members who provided informal care to individuals post-operatively. I have organized data using three storylines: being patient, negotiating care, and mending fault lines. There are two layers of my analysis: our individual encounters with carers alongside our changing embodiment and the broader care relations of the system, increasingly influenced by neoliberalism. Care is increasingly informalized and commodified as austerity measures cut public financing for care and services are de-listed. Neoliberalism produces poor and precarious working conditions for nurses and personal support workers and this translates into insufficient care for patients and support for families. With care increasingly being shifted to the home and community, individuals and families are taking on more responsibility in terms of caring for family members. / Dissertation / Doctor of Philosophy (PhD) / In this study I explore care in Ontario, Canada both as a patient and as a researcher with background in disability studies and social geography. I observed care and recorded fieldnotes as a patient researcher over thirty-two months and interviewed a total of nine people who underwent hip or knee replacement surgery about their experiences of care pre and post-operatively. Two daughters of participants also took part in interviews. I explore our individual stories of care and how the broader health system helps to shape our encounters with health care workers. Government reductions in funding for care and the de-listing of services translates into poor working conditions for health care workers and insufficient care for patients. The responsibility for care is increasingly being shifted from the state to individuals. My research reveals how patients manage within this fragmented system made up of formal, informal, and private care arrangements.

The biomedical conceptualisation of “depression” as a disease entity stems from biological science rooted in a 17th century paradigm, and is an inappropriately positivist idea which discounts individual agency, disregards social context underscored in the descriptive epidemiology, fails to accommodate inter-subjectivity and process, medicalizes suffering, and serves a managed care model of health administration. A qualitative study using in-depth interviews was undertaken to elicit perspectives from individuals who had lived experience of biomedical (pharmacological) treatment for affective distress and who self-reported having attained satisfactory recovery. Thematic analysis of interview data clustered around three main categories: (1) multifactorial conceptual understandings; (2) context pertinent to the experience of distress and recovery – including a variety of stressors – and (3) trajectories of recovery from acute distress to negotiation of ambivalence toward treatment, enlisting of supports, and reclaiming of agency. Relationships with service providers marked by trust, empathy, and hope were valued as primary difference-makers. / May 2017

Bakgrund: Prostatacancer är den vanligaste cancerformen som drabbar män i Sverige. Sjukdomen skapar olika besvär som påverkar männens dagliga liv. Under sjukdomsförloppet upplever männen att de förlorar sin värdighet. Som sjuksköterska är det viktigt att se till hela patienten och ge en personcentrerad omvårdnad utifrån omvårdnadsdiagnoser. Syfte: Att belysa mäns upplevelse av att leva med prostatacancer. Metod: Litteraturstudie med kvalitativ design. Data hämtades från 12 vetenskapliga artiklar. Resultat: Studien utmynnade i fem kategorier som männen upplevde: informationsbehov, förlorad värdighet, oro för egen dödlighet, upplevelse av olika stöd och anpassning av vardagen. Slutsats: Männens vardag påverkas av sjukdomen prostatacancer och de behöver stöd i olika former. Sjuksköterskan bör möta männen på deras nivå och ge männen en individanpassad omvårdnad. / Background: Prostate cancer is the most common form of cancer that afflicts men in Sweden. The affliction creates different struggles that affect the men’s daily lives. During the progress of the disease the men experience a loss of their dignity. As a nurse it is important to care for the patient as a whole and provide a personal care, related to the nursing diagnosis of the patient. Aim: To shed light on the experiences of the men who are currently living with prostate cancer. Method: A study of literature focusing on qualitative data. Data was gathered from 12 scientific articles. Result: The study led to five categories that the men experienced: The lack of information, loss of dignity, anxiety surrounding own mortality, experience of different support forms and adjustment of the everyday life. Conclusion: The men’s daily lives are affected extensively by the disease prostate cancer and they need different forms of support. The nurse should level with the men in order to provide an individual care.

The landscape of cancer care is evolving and as a result nursing care continues to develop and respond to the changing needs of oncology patients and their families. There is a paucity of qualitative research examining the experience of being an oncology nurse on an inpatient unit. Therefore, a qualitative study using an interpretive phenomenological approach has been undertaken to discover the lived experience of being an oncology nurse. In-depth tape recorded interviews has been conducted with six oncology nurses who worked on two adult inpatient oncology units. Van Manen’s (1990) interpretive phenomenological approach has been used to analyze the data by subjecting the transcripts to an analysis both line by line and as a whole. The overarching theme of the interviews is: Investing to Make a Difference. The themes that reflect this overarching theme are: Caring for the Whole Person, Being an Advocate, Walking a Fine Line, and Feeling Like You are Part of Something Good. Oncology nurses provide care for their patients through a holistic lens that further enhances how they come to know their patients. Over time, relationships with patients and families develop and these nurses share that balancing the emotional aspects of their work is key in being able to continue to invest in their work and in these relationships. Their investment is further evident as oncology nurses continuously update their knowledge, for example, of treatment regimes, medication protocols, and as they champion their patients wishes and needs. As nurses develop their own identities as oncology nurses, they in turn enhance the team with their emerging skill and knowledge. These research findings serve to acknowledge the meaning of oncology nurses’ work and inform the profession’s understanding of what it means to be an oncology nurse.

Background: A wealth of quantitative literature exists exploring the impact of parental alcohol misuse on adult and child offspring. It is often proposed that children of alcoholics are at risk of experiencing a host of negative outcomes, many of which are said to persist into adulthood. Confusing and contradictory results have led researchers to identify a subset of offspring deemed to be resilient. Little remains known about the factors that influence who becomes negatively affected and who becomes resilient, or how these factors are experienced by individuals. The recent up rise of qualitative methodologies also suggest this divide is not clear, with offspring of alcoholics demonstrating a range of functioning. Aim: With this in mind, the current study aims to explore the lived experience of adult children of alcoholics to gather a richer understanding of how these individuals develop into the people they are today. Method: Semi-structured interviews were conducted with six individuals who grew up with at least one alcoholic parent. Interpretative Phenomenological Analysis was used to analyse verbatim transcripts. Results: The analysis produced four master themes. These were: ‘Dealing with the loss of connection to parents’, ‘Feeling hopeless and helpless’, Struggling to stay sane’ and ‘I know who I want to be more than I know who I am’. The master themes and corresponding subordinate themes are discussed in relation to the relevant literature. Clinical implications, methodological considerations and directions for future research are also presented. Conclusions: This study provided insight into the lived experience of being an adult child of an alcoholic. It highlighted the challenges and struggles they faced in childhood and the ways in which they battled to overcome the difficulties they experienced to forge a preferred identity in adulthood. It also emphasised the importance of perceived parental rejection as the pathway to causing distress and the desire to be better than their parents as a pathway to resiliency.

Sammanfattning Bakgrund: Övervikt och fetma är ett växande problem i Sverige och i stora delar av världen. Överviktskirurgin har ökat kraftigt de senaste åren och är idag en utbredd metod för att behandla övervikt och dess följdsjukdomar. Trots att syftet med operationen är att minska risken för ohälsa så visar studier att personer som genomgått denna typ av behandling, konsumerar mer sjukvård än personer som behandlats med andra metoder mot sin fetma. Därav är det viktigt att få en djupare förståelse för hur personer som genomgår överviktskirurgi upplever sin situation i samband med ingreppet.   Syfte: Att beskriva personers upplevelser och behov i samband med överviktskirurgi ur ett vårdvetenskapligt perspektiv. Teoretisk utgångspunkt: Transitionsteorin utifrån Meleis et. al., (2000) har använts som teoretisk referensram till denna litteraturstudie. Metod: En systematisk litteraturstudie baserad på åtta vetenskapliga artiklar med kvalitativ ansats. Resultat: Tre teman framkom: Livet före operationen, Den första tiden efter operationen och En längre tid efter operationen. Livet före operationen beskrevs som en hopplös kamp mot vikten och beslutet att operera sig som en sista utväg. Informanterna hade stora förväntningar på operationens resultat, vilka med tiden inte alltid visade sig vara realistiska. Ingreppet beskrevs dock som en mycket positiv livsförändrande händelse. Gemensamt för informanterna var att de upplevde svårigheter med att behålla en hälsosam livsstil en längre tid efter operationen, vissa lyckades med detta, andra inte. Det framkom att informanter hade negativa erfarenheter av sjukvården. Diskussion: Resultatet visar ett behov av ökade förberedelser och stöd från sjuksköterskan inför operationen. Genom att understödja det hopp om ett hälsosammare liv, som uttrycktes efter operationen, kan sjuksköterskan motivera till livsstilsförändringar och därmed främja en hälsosam transition även på längre sikt. Resultaten tyder på att det finns ett omvårdnadsbehov som kvarstår många år efter ingreppet, samt att en god vårdrelation är av stor vikt för ett lyckat behandlingsresultat. / Abstract Background: Obesity is a growing problem in Sweden and in many parts of the world. Bariatric surgery has increased dramatically in recent years and is now a widespread method to treat obesity and its sequelae. Although the purpose of the surgery is to reduce the risk of illness, studies show that patients, who have undergone this type of treatment, consume more healthcare resources than those treated with other methods to manage their obesity. It is therefore important to better understand how individuals who undergo bariatric surgery experience their situation in the context of the intervention. Purpose: To describe individual´s experiences and needs associated with bariatric surgery from a caring science perspective. Theoretical basis: Theory of Transition by Meleis et. al. (2000) has been used as a theoretical framework for this study. Methods: A systematic literature review based on eight scientific articles with qualitative approach. Results: Three themes emerged: Life before the surgery, the first period after the surgery and a longer period after surgery. Life prior to the surgery was described as losing a battle against obesity and the decision to undergo surgery was regarded as a last resort. The respondents had high expectations of the surgery results, which in time did not always prove to be realistic. The procedure was described as a very positive life changing event. It showed to be common for the respondents to experience difficulties in maintaining a healthy lifestyle for a prolonged period of time after the surgery. However, some were able to achieve this whilst others were not. It was revealed that respondents had negative experiences of health care. Discussion: The results show a need for increased preparation and support from the nurse before surgery. By supporting the hope of a healthier life, as expressed after the surgery, the nurse can motivate lifestyle changes and thus promote a healthy transition in the longer term. The results suggest that there is a need for nursing care that persists for years after the procedure, and that a good care relationship is vital for a successful treatment outcome.

The growing complexities and dramatic changes in the contemporary health care system require nurses to practice successfully with essential professional knowledge and skills required for safe and competent practice. The implication is that nurse educators are confronted with the challenge to redefine effective teaching strategies appropriate to prepare nurses for the complexities of the current practice demands. To this end, student-centered teaching (SCT) has emerged in many undergraduate nursing curricula as a tool to develop essential practice skills in nursing students. A lack of understanding of how nurse educators experience SCT may hinder its success and sustainability. This qualitative study explored the lived experience of clinical nurse educators (CNEs) using SCT in the practice settings. Ten CNEs who self-identified as using SCT volunteered to participate. Data were collected using a semi-structured interview guide and audio recorder. Additional data source included a demographic survey and a reflective journal. Analysis of the CNEs’ perspectives revealed an overarching theme entitled “SCT in a non-student-centered world” with a variety of meanings of SCT from a humanistic point of view. Participants identified individual, staff, and contextual factors including policy issues that hinder successful implementation of SCT in the practice settings. The study also unveiled that a successful paradigm shift to SCT may not be the sole responsibility of the CNEs but a joint endeavor by all stake-holders within the health care delivery system. Findings of this study may be used by nursing and health sciences faculty and administrators to guide policy and program planning that incorporates student-centered clinical education. / October 2016