Background: An estimated 125 million women live with Female Genital Mutilation (FGM) worldwide. Despite it being internationally recognized as a human rights violation. FGM is still practiced in approximately 29 countries, most of them in Africa and the Middle East. FGM has no health benefits, whereas there are short and long terms negative consequences that can cause physical and psychological problems. Aim: To describe the experiences of women who live with FGM and their subsequent interactions with healthcare providers in countries where FGM is not a tradition. Method: A literature study based on ten studies with a qualitative research design. Results: Five main themes were found; Knowledge of FGM, Language Barriers, The Gender of Healthcare Provider, Interactions with Healthcare Provider and On Display. Conclusion: Patients had difficulties due to the language barriers. There was a preference for female healthcare providers. Patients were affected by interactions with healthcare providers as well as lack of knowledge. Patients also had their genitals put on display for others. Clinical significance: With increasing migration, it is important that healthcare providers do not judge, but instead treat and care for these women with respect and empathy. / Bakgrund: Runt 125 miljoner kvinnor i världen idag är könsstympade, även fast det är internationellt erkänt som ett brott mot de mänskliga rättigheterna. Trots detta praktiseras könstympning fortfarande i cirka 29 länder, mestadels i Afrika och i Mellanöstern. Det finns inga hälsovinster för kvinnor som är könsstympade, däremot medför det kort- och långsiktiga negativa konsekvenser som kan leda till fysiska och psykiska problem. Syfte: Att beskriva könsstympade kvinnors erfarenheter av vårdpersonal i länder där det inte finns någon tradition av könsstympning. Metod: En litteraturstudie baserad på tio studier med kvalitativ ansats. Resultat: Fem huvudteman framkom och beskrevs; Kunskap om könstympning, Språksvårigheter, genus av personal, samspelet med vårdgivare och att den könsstympade kvinnan kände sig uttittad av vårdpersonalen. Slutsats: Patienterna hade svårt att kommunicera med sjukvårdspersonalen. Patienterna föredrog kvinnlig sjukvårdspersonal. Interaktionen med sjukvårdspersonalen påverkade patientens relation till vården. Patienterna kände sig uttittade av sjukvårdpersonalen. Patienterna upplevde att vårdpersonalen hade kunskapsbrister om FGM. Klinisk betydelse: Med ökad migration är det nödvändigt att vårdpersonalen ger en respektfull vård och visar empati för de könstympade kvinnorna.

This study addressed three research objectives related to non-Muslim nurses’ experiences providing health care to Muslim patients in Saudi Arabian hospitals. These objectives included: first, understanding what it is like to care for Muslim patients considering both religion and culture; secondly, exploring what it is like being cared for by non-Muslim nurses. In order to address these objectives, the study has employed a qualitative approach, represented in hermeneutic phenomenology. The target groups in this study were Muslim patients and non-Muslim nurses who were interviewed using interviews and focus group discussions. The study found that religious, cultural and linguistic factors have a negative effect on non-Muslim nurses’ experience of care in Saudi Arabia, which included a personal impact, and a practical impact resulting from working practices. However, the results indicated that nurses had some problems with family members who interfered in decisions related to patients, and that they also encountered disrespect from patients’ relatives and friends. The study results indicated that non-Muslim nurses, to some extent, have an understanding of the different aspects and practices of Islam, such as praying, fasting and spirituality. The study results also revealed a significant relationship between spirituality (Islamic faith) and the provision of health care. Nurses believe that religious and spiritual practices have an effect on care. However, they failed to understand the importance of religion and spirituality to Muslims in general and patients in particular. The lack of training and orientation concerning specific issues of religion and culture negatively affected not only the communication between nurses and patients, but also the provision of health care. It was envisaged that this study would have a positive impact on the delivery of nursing training and education, because it highlights the need to tailor this to specific contexts. The study distinguishes itself from other studies conducted in the same field by investigating non-Muslim nurses’ and Muslim patients’ confusion between religion and culture. The study stressed an overlap between religion and culture in Saudi society, which consequently affected nurses’ provision of health care. It was essential in this study to investigate the differences between religion and culture, to see of non-Muslim nurses would understand religion and culture are not the same; while in some cases they complement one another, in other cases they contradict. Furthermore, the study addressed the issue of professionalism when caring for Muslim patients’ and non-Muslim nurses’ point of view. Although nurses claimed to provide healthcare in professional way, they were not fully aware of Saudi local culture or the impact of religion on patient’s daily life It can be concluded, in general, that non-Muslim nurses are facing challenges to providing healthcare to Saudi Muslim patients, due to a lack of understanding of the importance of cultural values and religious practices, and the lack of training and alignment on such issues.

Syfte: Syftet var att undersöka föräldrars upplevelser av bemötande på barnvårdhälsocentral/sjukhus efter genomförd omskärelse av deras son/söner. Metod: Studien hade en kvalitativ och induktiv ansats och genomfördes på en öppen förskola i en förort i Stockholm, hösten 2013 och våren 2014. Urvalet skedde genom att författaren valde föräldrar till barn som hade blivit omskuren och som kunde ge informationsrika beskrivningar av fenomenet. Totalt sju föräldrapar medverkade i studien. Samtliga föräldrar hade omskurit sin son/söner i Sverige. Datainsamling skedde genom semistrukturerade intervjuer vilka analyserades med hjälp av en kvalitativ innehållsanalys. Resultat: Föräldrars upplevelse av bemötande efter genomförd omskärelse av sin son/söner sammanfattades i tre teman. I upplevelse av ett tillfredställande och professionellt bemötande beskrev föräldrarna de faktorer som bidrar till ett bra bemötande, där det bland annat framkom att respekt och förståelse för föräldrarnas värderingar är av betydelse för att skapa en trygghet och förtroende för vårdpersonalen. Föräldrarna beskrev sina upplevelser av ett bristande bemötande genom att uttrycka att vårdpersonal brast i sitt engagemang, var stressade, svåra att få tag på och brast i att ge information och rådgivning. Dessa upplevelser lämnade föräldrar att önska mer av vårdpersonalens bemötande i temat ett önskat bemötande, där föräldrarna uttryckte önskemål om en engagerad vårdpersonal som kommunicerar, ger adekvat information och rådgivning samt har goda kunskaper och utbildning om andra kulturer. Slutsats: Föräldrarna upplevde både positiva och negativa upplevelser med bemötandet hos vårdpersonalen, där bristande transkulturell kunskap hos vårdpersonalen var ett av de största problemen. Kontinuerlig utbildning om transkulturell omvårdnad kan underlätta för vårdpersonalen i deras möte med människor från andra kulturer. / ABSTRACT Aim: The aim of this study was to describe parents' experiences of treatment at child health care/hospital after circumcision of their son/sons. Method: The study had a qualitative and inductive approach and was conducted at a open pre-school in a suburb in Stockholm, in fall 2013 and spring 2014. The author chose the parents of children who had been circumcised and who could provide good information descriptions of the phenomenon. A total of seven pair of parents participated in the study, all whom circumcised their son/sons in Sweden. The data collection was carried out through semi structured interviews which was analyzed with the help of a qualitative content analysis. Result: Parents’ experience of treatment after the circumcision of their son/sons was summarized in three themes. The experience of a satisfactory and professional treatment, parents described the factors that contribute to a good treatment, which among other things, showed that respect and understanding of parents' values are important to create a sense of security and confidence for caregivers. The parents described their experiences of a lack of treatment by expressing that the nursing staff lacked in commitment, was stressed, difficult to reach and lacked in giving information and advice. These experiences left parents wishing for more of the care attitude of the nursing staff in the theme a required treatment, in which the parents wished for a dedicated nursing staff who communicate, provide approriate information and advice and has good knowledge and education about other cultures. Conclusion: Parents experienced both positive and negative experiences with the treatment of nursing staff, where the nursing staffs lack of transcultural knowledge was one of the biggest problems. Continuous education of transcultural care can help nursing staff in their meeting with people from other cultures.

Bakgrund: Palliativ vård syftar till att ge stöd och lindring till döende patienter för att främja livskvalitet oavsett vilken etnisk bakgrund man har. Vårt samhälle är mångkulturellt och idag möter sjuksköterskor allt fler invandrarpatienter som kan ha olika uppfattning om hälsa, sjukdom, döendet och döden. Detta innebär att det kommer att ställas andra eller nya krav på vårdpersonalen. Syfte: Att beskriva sjuksköterskors erfarenheter av att vårda patienter med annan etisk bakgrund än de själva vid palliativ vård. Metod: En litteraturöversikt över elva vetenskapliga kvalitativa artiklar genomfördes. Artiklarna har eftersökts i databaserna CINAHL Complete, pubMed och SveMed+. Dessa kombinerades i olika konstellationer för att få fram sökträff som svarade på syftet. Sökord som användes var: transcultural nursing”, ”multicultural”, ”palliative”, immigrants”, ”nurse”, ”experience”, “attitude”. Resultat: Resultat visar att många sjuksköterskor upplevde att det var svårt att bemöta invandrarpatienter. Kommunikationssvårigheter var ett vanligt problem vid kulturmöten. Att vara kulturellt medveten, och ha förståelse för kulturer och sedvänjor, samt visa hänsyn till individualitet var enligt sjuksköterskorna viktiga faktorer som kunde förbättra palliativ vård till invandrarpatienter. Diskussion: Resultatet diskuteras med stöd av Madeleins Leiningers omvårdnadsteori som utgångspunkt, där främst diskuterades. Vidare diskuterades vilken kulturell kompetens som behövs för att sjuksköterskan ska kunna ge en god transkulturell omvårdnad. / Background: The aim of palliative care is to provide support and relief to dying patients in order to indorse the quality of life regardless of their ethnical background. Our society is multicultural. It is more common today that nurses meet patients with different ethical cultural backgrounds who may hold different opinions about health, illness, dying and death. This means that it will impose to or new requirements for caregivers. Aim: To describe nurses' experiences of caring for patients with different ethical background than themselves in palliative care. Method: The method that was used is a qualitative literature review. Eleven scientific qualitative articles are included in this study. Articles have been sought in the databases CINAHL Complete, PubMed and SveMed +.Selected. These were combined in different configurations to retrieve a search result that responded to the purpose. Keywords used were :”transcultural nursing”, ”multicultural”, ”palliative”, immigrants”, ”nurse”, ”experience”, “attitude”. Results: The result shows that many nurses felt difficulties to approach immigrant patients. Communication difficulties were the common problem in cultural encounters. To being culturally aware, to understand the cultures and customs, and to take the individuality was as nurses important factors that could improve the palliative care of migrant patients. Discussions: The results are discussed with the support of Madeleine Leininger nursing theory as a basis, which mainly discussed. Further discussed about which cultural competence is needed for the nurse to be able to provide good transcultural nursing.

The central theme or 'red-thread' that I consider in this thesis is the concept of risk as it is perceived by and affects the two sides of the medical encounter -in this instance ethnic Pakistanis and Health Professionals- in Britain. Each side very often perceives risk quite distinctively, relating to the balance between the spiritual and temporal realms. This is particularly germane in matters to do with possible congenital defects within the prenatal realm for the ethnic Pakistani, and predominantly Muslim, side of this encounter. Thus one of the factors considered in this thesis is how senses of Islam impact upon the two sides. By ethnic Pakistanis Islam is seen as central to all life decisions, whilst Health Professionals view Islam with some considerable trepidation, little understanding it or its centrality to the former's decision-making processes. This is particularly significant with regard to attitudes to health and health care. In the initial stages of the project I had thought first cousin marriage (FCM), seen by ethnic Pakistanis as desirable and by Health Professionals as putting ethnic Pakistanis at-risk to be central to the argument, but concluded that concerns around FCM were a 'red herring', merely a trope for the tensions between the two sides -at once both British and at-risk from audit culture. Although no longer central, FCM remains a viable touchstone in consideration of the two sides' perceptions of genetic risk. In this thesis the medical encounter between ethnic Pakistanis and Health Professionals is performed within the realm of the so called New Genetics. Here the respective understandings of the New Genetics are informed by the enculturation processes that shape the two sides' world view. Furthermore, I will agree with Lord Robert Winston's and others' concern that any attempt to eradicate an adaptive genetic mutation, in this instance, thalassaemia, from the gene pool is not only undesirable in the short term, but also that such eradications may have an adverse, and far reaching, effect on whole population groups in the future. The main thrust of my argument is that audit culture not only compounds risk for both sides, but also perpetuates institutional racism within the National Health Service (NHS), by promulgating what I have called the language myth. That is to say that much institutional racism is the unwanted by-product of the NHS's attempts to become more patient centred and its continuing efforts to develop systems of best practice. This professionalisation process within the NHS can be seen to impact most strongly in relation to communication -particularly the claimed language barrier between the two sides. This 'barrier' has worrying policy implications for any meaningful communication between the two sides, notably relating to obtaining informed consent from ethnic Pakistani patients -with a resultant increase in risk for the two sides and clear economic consequences for the NHS.

Sverige har gått från ett monokulturellt samhälle till ett mångkulturellt samhälle. En allt större del av Sveriges befolkning består av människor med olika kulturella och etniska bakgrunder. Det senaste decenniet har kombinationen av en åldrande befolkning med varierad etnisk och kulturell bakgrund ställt nytt krav på svensk hälso- och sjukvård. Detta innebär att sjuksköterskor kommer att träffa människor från olika kulturer och med olika vård behov. Med detta i beaktande är det betydelsefullt att belysa vikten av kulturell omvårdnad och kulturkompetens i mötet med patienten. Bakgrund: Patienter med annan etnisk bakgrund kan vara sårbara på grund av de problemen som inträffar när de flyttar till ett nytt land. Kulturella skillnader och språk svårigheter kan vara ett hinder för patienten att söka eller få adekvat vård. Syfte: Att belysa kulturens betydelse i omvårdnadsarbetet. Metod: En litteraturstudie utförs för att kunna besvara syftet. Tio vetenskapliga artiklar har valts ut. Nio av de valda artiklarna har en kvalitativ ansats och en är en blandning av kvantitativ och kvantitativ ansats. Resultat: Sju kategorier identifierades i studien; Språk och kommunikation, Samarbeta med anhöriga, Sjuksköterskan attityder och uppfattningar, Betydelse av utbildning, Vikten av kulturell kompetens inom omvårdnad, Sjuksköterskans yrkesroll samt Patient perspektiv. Slutsats: Resultatet påvisar de berörda kategorier i studierna som har betydelse i vårdande av patienter från annan kultur. Studien fokuserade på att belysa betydelsen av kulturen i omvårdnadsarbetet. De flesta studierna här huvudsakligen berört sjuksköterskorna men i resultat delen lyfts bland annat patientens perspektiv fram vilket uppsatsens författare tycker att det kan bidra till att skapa medvetenhet hos alla hälso-sjukvård personal inom olika områden. / Sweden has changed from a monoculture society to a multicultural society. A big part of the Swedish population today consists of people with different cultural backgrounds. These past decades the combination of the ageing population with different cultural backgrounds has put new demands on the Swedish health sector. This means that nurses today and in the future will meet patients from different cultures and with various health needs. Putting this in consideration it is significant to highlight the importance of cultural care and cultural competence in nursing encounter. Background: Patients with different ethnicity can be vulnerable because of problems they face when they move in the new country. Cultural differences and language barriers can be one of the obstacles for a patient to receive sufficient health care. Aim: The purpose of this study is to illustrate the importance of cultural care and cultural competence and the effects it has in nursing. Method: A literature study is designed to answer the aim of the study. Nine qualitative scientific articles and one article composed of both quantitate and qualitative are selected for the study. Results: seven categories were identified in the study: Communication and language barriers, education, cooperation with relatives, nurse’s attitudes, cultural competence, patient perspectives and nursing profession role. Conclusion: The result demonstrates categories in the studies that are important in caring for patients from other cultures. The study focused on highlighting the importance of culture in nursing. Most studies where about nurses but in the results section highlights include the patient's perspective, which essay writers feel that it can also help create awareness among all health care professionals in various fields.

Some cultures regard pain as a natural part of life compared with the Western culture which believes that pain is something unnatural and that has to be eliminated. Transcultural nursing is a way to learn about and provide culturally fitting and meaningful care to people with different cultures. Tanzania suffers from a lack of qualified health workers due to an increased burden of disease and this affects the quality and supply of effective health services. It has been seen that it is common for patients to get inadequate pain treatment and this results in many different complications. The aim of the study was to describe the nursing care of patients with postoperative pain at a rural hospital in Tanzania. The study was implemented at the Kilimanjaro Christian Medical Centre in Moshi. A qualitative participating observation study with an ethnographic approach was used to collect the data. The data was analyzed by content analysis and resulted in three themes: 1. The role of the nurse, 2. Pain management, and 3. Meeting the patient. The conclusion was that the nursing care around patients with postoperative pain showed an extended collaboration between the nurses and other health care professionals as well as with the patients’ parents. The study further showed that the atmosphere around the patients was positive and calm and that the nurses assessed pain by measuring vital signs and facial expressions.

Cette thèse offre une étude comparative qui fait appel aux productions filmiques et littéraires d’artistes francophones, afin de mieux saisir les notions de migration et de transculturalité dans leurs œuvres. Ces thèmes sont analysés de part des notions de genre, de sexualité et de trauma dans les productions cinématographiques de Ousmane Sembène, Lionel Steketee (avec Fabrice Eboué et Thomas N’gijol), Moussa Touré et Yamina Benguigui. Dans le champ de la littérature francophone, sont analysées les œuvres de Fabienne Kanor, Gisèle Pineau, Maryse Condé et Myriam Warner-Vieyra. L’étude des configurations migratoires et transculturelles du migrant dans les arts visuels est suivie de l’examination des enjeux identitaires et questions d’exploitations du corps de la femme noire ainsi que l’acte de la mémoire dans les œuvres romanesques de Kanor et de Pineau. Le dernier point d’analyse se centre sur les œuvres de Maryse Condé et de Myriam Warner-Vieyra afin de mettre en exergue les procédés par lesquels la transculturalité mène à la réalisation d’une littérature monde. L’observation des configurations géoculturelles des migrants permettra de mieux saisir les complexes notions d’intégration qui s’opèrent dans les pays d’accueil. Cette approche interdisciplinaire nous amène à explorer les notions de genre, de sexualité, de trauma, de construction identitaire et de résistance dans les arts visuels et dans la littérature francophone d’artistes de la diaspora africaine. Elle permet également de mieux comprendre leurs contributions au renouveau de la création littéraire et de la production cinématographique francophone. This thesis offers a comparative study that centers on the filmic and literary productions of Francophone artists. It provides an examination of notions of migration and transculturality in their works. These themes are analyzed through issues of gender, sexuality and trauma in the cinematographic productions of Ousmane Sembène, Lionel Steketee (with Fabrice Eboué and Thomas N'gijol), Moussa Touré and Yamina Benguigui. In the field of Francophone literature, this analysis expands to the works of Fabienne Kanor, Gisèle Pineau, Maryse Condé and Myriam Warner-Vieyra. Looking at film, we first observe the migrants' migratory and transcultural configurations. A second phase of analysis focuses on an examination of issues of identity formation, the exploitation of black women and the act of memory in the novels of Kanor and Pineau. The last point of analysis centers on the works of Maryse Condé and Myriam Warner-Vieyra to highlight the processes through which transculturality leads to a "littérature-monde." Through a critical study of the migrants' geocultural configurations, this thesis stresses the complex issues of integration that take place in the host country. This interdisciplinary study is an exploration of notions of gender, sexuality, trauma, identity construction and resistance in the visual and literary productions of Francophone artists from the African Diaspora. It also provides a better understanding of these artists' contribution to the renewal of literary creation and that of francophone film production.

Att fly från sitt ursprungsland på grund av krig och förföljelser påverkar flyktingars psykiska hälsa. Flyktingar har till stor del varit med om traumatiska händelser som de kan ha ett behov av att dela med sig av till hälso- och sjukvården. Hälso- och sjukvården kan möta krigsdrabbade flyktingar där det kan vara problematiskt att de talar ett annat språk och kommer från en annan kultur. Därför var syftet att belysa flyktingars upplevelser av hälso- och sjukvården. I litteraturstudiens resultat ingick 11 vetenskapliga artiklar som analyserats med hjälp av en innehållsanalys. Det framkom tre huvudteman ur analysen. De namngavs till Språkliga barriärer, Kulturella faktorer och Varierande förtroende för hälso- och sjukvården. Sjuksköterskan kan dagligen möta flyktingar i hälso- och sjukvårdsorganisationen, både inom primärvård och i slutenvård. Det är därför viktigt att sjuksköterskan har kunskaper om flyktingars upplevelser av hälso- och sjukvården för att kunna bedriva en god transkulturell omvårdnad. Det är således betydelsefullt med en bra kommunikation mellan hälso- och sjukvårdspersonal och flyktingar, vilket försvåras av språksvårigheter och kulturella olikheter. / To escape from their countries of origin because of war and persecution affects refugees’ mental health. Many refugees have been through traumatic events that they may have a need to share with the health care. The health care may face war-affected refugees which can be problematic because they speak a different language and come from a different culture. Therefore, the aim was to highlight the refugees experience of the health care. In this literature review, results of 11 scientific articles were analyzed using content analysis. The three main themes that emerged in the analysis were Language barriers, Cultural differences and Varying trust in health care. The nurse can daily meet refugees in the health care organization, both in primary care and in hospital. It is therefore important that the nurse has knowledge of refugees’ experiences of health care in order to conduct a good transcultural nursing. It is thus important with good communication between health care personnel and refugees, which is hampered by language difficulties and cultural differences.

The essence of the thesis is to answer the best possible way the theoretical and empirical question how national identity reflects the transcultural turnover (Kreuzzieger, 2012a, 2012b). The concept of transcultural turnover includes theories which consider the cultural aspects of contemporary accelerating globalization, including a premise of weakening of the nation-state in terms of its cultural homogeneity (Welsch, 1999, 2000), which is seen as one of the pillars of national identity (Hall, 1992; Anderson, 2008; Tomlinson 2003). Answers to the raised questions are by some authors conceptualized differently, and as such, in the form of hypotheses, the answers enter the empirical part of this thesis and there they are tested for 16 selected European countries thanks to the publicly available data from a survey of national identity. The research was carried out by ISSP in 1995 and 2003. There are also used some other sources of aggregate data such as GDP level or index of globalization. From the statistical analysis there is hierarchical cluster analysis, correlation analysis and Z-test of proportions. The real effect of transcultural turnover to change the form of national identity can not be on the basis of the empirical part of this thesis excluded, given the fact that the national identities of...