Rozprawy doktorskie na temat „Shame in nursing”

This study explored the experience of shame in nursing using an interpretive phenomenological approach as described by van Manen (1997). Shame is a concept that has been extensively theorised within the social sciences as important in the development of individual identity, self esteem and role performance but overlooked in nursing. The purpose of this research was twofold; to gain an understanding of how shame influences and shapes nursing identity and to produce knowledge and stimulate dialogue about what that means for nursing culture. Participants were asked to discuss significant interactions with colleagues. Significantly, all disclosed the experience of shame. Further, four major themes emerged from this study to deepen understanding of what appears to be a cultural experience. The experience of shame involves: self appraisal, professional identity in conflict, the experience of isolation and recrimination. Within each theme a number of sub themes were identified including feeling dumb, being incompetent, withdrawing and going quiet and seeking revenge. The study concluded that in relation to nursing, internalised shame is not readily recognised although negative emotions that are linked to it are clearly felt. When these emotions are left unprocessed or unidentified as shame, then they are likely to have negative consequences. But recognising this hidden shame and bringing it to conscious awareness can express and perhaps relieve shame. Further, shame's adaptive functions, to provide moral direction and teach respect, could be acknowledged or reclaimed. It is argued therefore that acknowledging and discussing shame openly in nursing, such as through future research, scholarships and education, will facilitate consciousness raising and the potential for cultural change.

This study explored the experience of shame in nursing using an interpretive phenomenological approach as described by van Manen (1997). Shame is a concept that has been extensively theorised within the social sciences as important in the development of individual identity, self esteem and role performance but overlooked in nursing. The purpose of this research was twofold; to gain an understanding of how shame influences and shapes nursing identity and to produce knowledge and stimulate dialogue about what that means for nursing culture. Participants were asked to discuss significant interactions with colleagues. Significantly, all disclosed the experience of shame. Further, four major themes emerged from this study to deepen understanding of what appears to be a cultural experience. The experience of shame involves: self appraisal, professional identity in conflict, the experience of isolation and recrimination. Within each theme a number of sub themes were identified including feeling dumb, being incompetent, withdrawing and going quiet and seeking revenge. The study concluded that in relation to nursing, internalised shame is not readily recognised although negative emotions that are linked to it are clearly felt. When these emotions are left unprocessed or unidentified as shame, then they are likely to have negative consequences. But recognising this hidden shame and bringing it to conscious awareness can express and perhaps relieve shame. Further, shame's adaptive functions, to provide moral direction and teach respect, could be acknowledged or reclaimed. It is argued therefore that acknowledging and discussing shame openly in nursing, such as through future research, scholarships and education, will facilitate consciousness raising and the potential for cultural change.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Nursing and Midwifery
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Begreppet skam är ett mångdimensionellt subjektivt begrepp. Vid sjukdom kan kroppen upplevas som annorlunda och patienten är ibland i behov av hjälp som tidigare inte behövdes vilket kan väcka känslor av skam. Vid känslan av skam upplever individen en blottning av jaget där aspekter som känslighet, intimitet och sårbarhet visas. Syftet med studien var att belysa vad skam är och kan vara inom omvårdnad och genomfördes som en systematisk litteraturstudie. Tio vetenskapliga artiklar användes till studiens resultat och tre teman kunde identifieras; "Mänsklig skam i vårdandet och miljön: det förminskade jaget", "mänsklig skam i vårdandet och miljön: det förlorade jaget" och "mänsklig skam i vårdandet och miljön: det försvarande jaget". Sjuksköterskans bemötande är en viktig aspekt i patientens känsla av skam då ett respektfullt, tryggt och förstående bemötande som främjar patientens autonomi kan minska känslan av skam. Relativt lite forskning har genomförts kring begreppet skam inom vårdvetenskapen, genom att öka sjuksköterskan medvetenhet samt kunskap om skammens olika uttryck kan känslan av skam identifieras hos patienten och lindras genom god omvårdnad.
The concept of shame is a multidimensional subjective concept. The body can be perceived as different during illness and the patient is sometimes in need of help that earlier was not needed which can arouse feelings of shame. During the feeling of shame the individual can perceive its self as exposed where aspects such as sensitivity, intimacy and vulnerability is showed. The purpose of the study was to illuminate what shame is and can be within nursing and was performed as a systematic literature study. Ten scientific articles were used in the result of the study and three themes were identified; "Human shame in the caring and the environment; The diminished self", "human shame in the caring and the environment: The lost self" and "human shame in the caring and the environment: the defending self". The nurse's response is an important aspect in the patient's feeling of shame since a respectful, safe and understanding response that promotes the autonomy of the patient can reduce the feelings of shame. Relatively little research has been performed in the concept of shame within the caring science, through increasing the nurse's awareness and knowledge about the different expressions of shame, the feelings of shame can be identified in the patients and be alleviated through good caring.

Sammanfattning Bakgrund Kronisk obstruktiv lungsjukdom orsakas ofta av rökning, vilket anses av de flesta vara en självförvållad sjukdom. Konsekvenserna av detta blir att patienter med KOL ofta upplever skuld och skamkänslor. Syfte Syftet med denna litteraturstudie är att beskriva patienters erfarenhet av skuld och skam vid kronisk obstruktiv lungsjukdom. Metod I litteraturstudien granskades åtta vetenskapliga artiklar för att få en kunskap om patienternas känslor kring sin sjukdom. Innehållsanalys användes med ett deduktivt förhållningssätt där data bearbetades för att identifiera mönster och teman. Resultat Två huvudkategorier; skuld och skam var från början definierade och under analysen identifierades en tredje; stigmatisering. Dessa kunde senare delas in i tre olika nivåer; individ, familj/omgivning och sjukvård. Konklusion Denna studie ger sjuksköterskan en bättre förståelse för vilka känslor som kan uppstå vid en ofta självförvållad sjukdom som KOL. Den visar också vikten av att möta patienterna med empati, respekt och höja deras känsla av värdighet och moral.

Syfte: Syftet med studien var att belysa strokedrabbade patienters upplevelser avätsvårigheter. Bakgrund: Varje år insjuknar ca 33 000 personer i stroke i Sverige. Omkring hälften av dessa upplever ätsvårigheter. Ätsvårigheter definieras som svårigheter som, ensamma eller tillsammans, inverkar negativt på förberedelsen och intagandet av mat och dryck. Metod: Detta är en litteraturstudie med artiklar hämtade från tre olika databaser: PsycInfo, Cinahl och Pubmed. Analysen av artiklarna gjordes genom att hitta textinnehåll i artiklarna som svarar mot syftet i denna studie. Dessa har format kategorier som redovisas i resultatet. Resultat: Fyra kategorier av upplevelser framkom: Ny tugg- och sväljproblematik, Försämrad matupplevelse och ork, Rädsla för att inte kunna kontrollera födointaget och Skam för sitt bordsskick. Slutsats: Sjuksköterskan kan med hjälp av metoder för bedömning av patientens ätsvårigheter hjälpa patienten att undvika negativa upplevelser. Om patienter känner skam och döljersina ätsvårigheter kan detta leda till att de inte orkar fullfölja en måltid. Det i sin tur kan leda till ett försämrat födointag och ett förvärrat hälsotillstånd. Med ett förhållningssätt till patientens individuella upplevelse av skam och rädsla kan sjuksköterskan försöka få patienten att sätta ord på hur han/hon känner sig och på så sätt förbättra ätsvårigheterna.
Aim: The aim of this study was to highlight the stroke affected patients' experience of eating difficulties. Background: Each year approximately 33 000 people are diagnosed with stroke in Sweden. About half of them experience eating difficulties. Eating difficulties are defined as difficulties that alone or together cause a negatively affect to the preparation and ingestion of food and drink. Method: This is a literature review of articles from three different databases: PsycInfo, Cinahl and Pubmed. The analysis of the articles was done by finding text content in articles that met the aim of the study. These formed then the categories as shown in the results. Results: Four categories of experiences emerged in the results: New chewing and swallowing problem, Impaired dining experience and stamina, Fear of not being able toc ontrol the food intake and Shame for ones table manners. Conclusion: The nurse can with acorrect assessment of the patient's eating problems help the patient avoid negative experiences. If patients feel shame and hide their eating problems can it result in not beingable to complete a meal. This in turn can lead to decreased food intake and a worsening health condition. With an individual approach to the patient's experience of shame and fear the nurse can try to get the patient to express how they feel, and this way improve the eating difficulties.

Upplevelsen av att leva med maligna tumörsår är unik för varje patient och fysiska symtom som smärta, lukt, läckage, blödning och klåda kan ge upphov till depression och social isolering. Syftet med litteraturstudien var att belysa patienters upplevelse av att leva med maligna tumörsår. En allmän litteraturstudie genomfördes med sju vetenskapliga resultatartiklar som tolkades i en innehållsanalys. Tre teman kunde urskiljas: Leva med en förlorad kropp, Leva med strategier för att hantera lidandet och Leva med en förändrad självbild och livsvärld. Resultatet påvisade en förnekelse över sårets existens hos patienten och ett behov av att dölja såret för sin omgivning. En ständig oro för att såret skulle synliggöras gjorde att patienten medvetet valde bort att uppsöka vård. Upplevelser av skam och att förlora kontrollen över den fysiska kroppen gav upphov till en förändrad självbild hos patienten. Genom samtal kunde patienten återta kontrollen över sin livssituation och bryta isoleringen från omvärlden. Hopp var en stark strategi som bidrog till att patienten återfick sin livskraft. Inom vetenskapen omvårdnad kan sjuksköterskan öka kunskapsunderlaget om existentiella mänskliga behov och begär i patienters levda värld med maligna tumörsår genom akademisk utbildning och forskning som minskar patienters lidande och främjar en evidensbaserad omvårdnadsprocess.
Living with malignant fungating wounds is a unique experience and physical symptoms can lead to depression and social isolation. The aim of the study was to illuminate patients' experiences of living with malignant fungating wounds. A general literature study was conducted by content analysis of seven qualitative articles. Three themes emerged: Living with a lost body, Living with strategies to deal with suffering and Living with a new identity and lifeworld. The result showed a denial of the wound's existence and a need to conceal the wound from its surroundings. A constant concern that the wound would be made visible meant that the patient deliberately chose not to seek care. Experiences of shame and loss of control of the physical body gave rise to a change in the patient's self-identity. Through conversations, the patient was able to regain control over their life situation and break the isolation from the outside world. Hope was a strategy that helped restore the patient's vitality. Within the nursing tradition, the registered nurse can require more knowledge and increase understanding on the existential human needs in these patients' unique lifeworld through further research and academic education to alleviate suffering and promote an evidence-based nursing process.

Suicid utgör fem gånger fler dödsfall jämfört med trafikolyckor i Sverige, vilket får förödande konsekvenser för många människor. Lidandet beskrivs vara outhärdligt inför självmordshandlingen. Sjuksköterskor behöver mer kunskap om hur människor som försökt ta sitt liv tänker om sin handling, följande litteraturöversikt avser öka kunskapen om hur sjuksköterskor kan bemöta och tala med en självmordsnära patient.
Suicide accounts for five times more deaths in Sweden compared to traffic accidents, which has devastating consequenses for many people. The suffering is described as unbearable before the act of suicide. Nurses need to gain knowledge about how people who try to take their lives think about their action in order to increase knowledge about how nurses can talk and respond to a suicidal patient.

Självstigma hos personer med allvarlig psykisk störning behöver undersökas med tanke på att den psykiska ohälsan ökar. Syftet med studien var att undersöka hur självstigma påverkat individer med allvarlig psykisk störning. Studien utfördes som en litteraturstudie och resultatet utgjordes av tre kategorier: Att bli sin diagnos, Att känna skam och Att känna hopplöshet. Självstigma påverkar personer med allvarlig psykisk störning genom att försvåra förutsättningarna till återhämtning. Kombinationen av en allvarlig psykisk störning och självstigma skapar negativa konsekvenser utifrån individens egna stereotypa och fördomsfulla föreställningar. Individerna har svårt att känna mening med livet och undviker att söka hjälp på grund av skam och hopplöshet. Detta i sin tur kan leda till förvärrade symptom och ökat lidande. Sjuksköterskan behöver därför vara medveten kring problematiken med självstigma och vara observant kring individens egna fördomar, skamkänslor och känsla av hopplöshet kring sin diagnos. Det är av vikt att skapa förutsättningar för empowerment i vårdsituationen. Interventioner och omvårdnad bör ha som målsättning att minska symptomen av självstigma hos individer med allvarlig psykisk störning. Interventioner torde kunna utformas, men behöver anpassas utifrån vilket samhälle som vården utförs i. Det finns begränsningar i aktuell forskning och fler studier där självstigma som fenomen belyses vore önskvärt, liksom longitudinella studier för att ge en djupare förståelse.
Severe mental illness is a growing health problem. Severe mental illness and self-stigma in combination needs to be examined to clarify what impact they have in combination for each individual. The purpose of this study was to examine what kind of impact self-stigma has to individuals with severe mental illness. The study was conducted as a literature review and the results consisted of three categories: Becoming ones illness Feeling of shame and Feeling of hopelessness. Self-stigma affects the individuals negatively and makes it harder for them to recover. The combination of severe mental illness and self-stigma creates negative consequences from the stereotypical and jaundiced. Individuals have problems with finding meaning of life and are reluctant to seek treatment for their symptoms because of the feeling of shame and hopelessness. In return the symptoms of the mental illness increases and provides more suffering and decreases the meaning of life. It is important that nurses are aware of and are mindful to the individuals prejudice, feelings of shame and hopelessness about their mental illness. Nurses need to make sure that it is possible to be empowered as a patient. Interventions and nursing that aim to reduce the symptoms of self-stigma in severe mental illness should be adapted to the prejudice of the society. More scientific research is needed because of the limited number of present studies concerning self-stigma. There is a need to further investigate self-stigma in severe mental illness. Preferably studies with longitudinal design that focus on the phenomenon self-stigma and how it affects people with severe mental illness, to give a greater understanding.

Bakgrund: Anorexia Nervosa är en av den vanligaste ätstörningen och drabbar främst yngre kvinnor. Sjukdomen leder till en förvrängd kroppsuppfattning och karaktäriseras främst av viljestyrd överdriven bantning. Långvarig och grav AN kan skada kroppens organ vilket kan vara livshotande. AN är den psykiatriska sjukdomen med högst dödslighetsgrad. Det är svårt att behandla patienter med AN då det finns ett motstånd från dessa patienter på grund av att de förnekar sina beteenden. Det kan även bero på stigman kring ätstörningar som finns i samhället, vilket leder till att patienter undviker eller uteblir från behandling. Syfte: Att beskriva unga kvinnors upplevelser av att leva med anorexia nervosa. Metod: En kvalitativ analys av narrativer tillämpades på sex bloggar från Google. Bloggarna var skrivna av kvinnor i åldrarna 16–26 år. Resultat: Ur analysen framträdde tre kategorier; Att skambelägga sig själv, Självhat och Begynnande sjukdomsinsikt med sju underkategorier. Konklusion: Studien kan leda till en ökad förståelse och kunskap kring patienters upplevelser av att leva med AN, vilket kan bidra till att sjuksköterskan kan utföra en mer personcentrerad vård.
Background: Anorexia Nervosa is one of the most common eating disorders and mainly affects younger women. The disease leads to a distorted body image and is characterized mainly by will-driven excessive dieting. Prolonged and severe AN can damage the body's organs which can be life-threatening. AN is a psychiatric disease with a high risk of death. It is difficult to treat patients with AN because there is resistance from these patients though they are in complete deny of their behaviour. It may also be due to the stigma surrounding eating disorders that exist in the community, which leads to patients avoiding treatments for their disease. Purpose: To describe young women's experiences of living with anorexia nervosa. Method: A qualitative analysis of narratives was applied to six blogs from Google. The blogs were written by women aged 16-26 years. Results: Three categories emerged from the analysis; To shame oneself, Selfhatred and Incipient desease insight with seven subcategories. Conclusion: The study can lead to an increased understanding and knowledge of patients' experiences of living with AN, which can help the nurse to provide a good person-centered care.

Bakgrund: Venös insufficiens är en kronisk sjukdom som kan orsaka venösa bensår. Livssituationen för patienter med venösa bensår förändras när de tvingas förhålla sig till symtom från såret såsom smärta, klåda, sårvätska och odör, samt till en långvarig läkeprocess med besvärande kompressionsbehandling. Av kliniska riktlinjer framgår att sjuksköterskan skall omhänderta patienten ur ett helhetsperspektiv, men sjuksköterskor har i tidigare studier uppgivit att de saknar nödvändiga kunskaper för att möta personen bakom såret. Syfte: Att beskriva patienters upplevelser av att leva med venösa bensår. Metod: Studien utformades som en kvalitativ litteraturstudie. Resultat: Patienter med venösa bensår kan uppleva skam för rinnande sårvätska, skrymmande bandage och odör. Sårrelaterad smärta leder till fysiska begränsningar, som i kombination med skam, oro och osäkerhet ger patienterna en begränsad tillvaro. Den långa och osäkra läkeprocessen leder till känslor av hopplöshet, sorg och maktlöshet. Slutsats: Begränsningarna som patienterna upplever kan leda till social isolering och nedsatt fysisk aktivitet. Maktlöshet, sorg och hopplöshet kan leda till en sämre hälsa. Ovanstående konsekvenser av den förändrade livssituationen kan i sin tur påverka sårläkningen negativt. Sjuksköterskan kan ge stöd till patienten genom att använda humor, skapa mötesplatser och tillämpa empowermentstrategier. Klinisk betydelse: Patienter kan uppleva ett bättre bemötande när sjuksköterskan har en god förståelse för de besvär som såren orsakar. Förståelsen kan även vara till hjälp när sjuksköterskor planerar stödåtgärder till patientgruppen.
Background: Venous insufficiency is a chronic disease that can cause venous leg ulcers. Living conditions of patients with venous leg ulcers are changed when they need to adapt to wound symptoms such as pain, itching, exudate and odour, as well as a prolonged healing process with disturbing compression therapy. Clinical guidelines show that nurses should have a holistic approach to patient care, but in previous studies nurses have indicated lack of necessary skills to meet the person behind the wound. Purpose: To describe patients' experiences of living with venous leg ulcers. Method: The study was designed as a qualitative literature study. Results: Patients with venous leg ulcers may experience shame for running exudate, bulky bandages and odour. Wound pain leads to physical limitations, which in combination with shame, anxiety and uncertainty gives patients a restricted life. The long and uncertain healing process results in feelings of hopelessness, sadness and powerlessness. Conclusion: Limitations that patients experience may lead to social isolation and reduced physical activity. Powerlessness, sadness and hopelessness may lead to poor health. The above consequences of the changed life conditions may in turn influence wound healing. Nurses can provide patients support by using humour, creating meeting places and applying empowerment strategies. Clinical significance: Patients may experience better treatment when nurses show a good understanding of the problems that wounds cause. Understanding can also be helpful when nurses plan measures to support the patient group.

Bakgrund: Kronisk obstruktiv lungsjukdom är en folkhälsosjukdom som finns i hela världen och som främst drabbar rökare. Sjukdomen är livslång och upplevs individuellt av varje drabbad person. Med sjukdomen tillkommer förändringar i vardagen för de som drabbas. Syfte: Syftet var att beskriva personers upplevelser av att leva med kronisk obstruktiv lungsjukdom. Metod: Litteraturstudie baserad på tio vetenskapliga studier, samtliga kvalitativa. Artiklarna är hämtade från Cinahl Complete och PubMed. Artiklarna har analyserats och redovisats i fyra huvudtema. Resultat: Resultatet redovisas i fyra tema; Att känna rädsla inför en oviss framtid, Att skämmas och anklaga sig själv, Att känna sig begränsad och missförstådd i vardagen, Att känna ångest och oro. Diskussion: Resultatdiskussionen fokuserar på hur vardagslivet påverkas för personer som lever med KOL. Vetenskaplig litteratur och Jean Watsons teori används för att belysa resultatet.

Bakgrund: Våld i nära relationer drabbar främst kvinnor. Normaliseringsprocessen får kvinnan att anpassa sig efter mannen, detta medför isolering, känslor av skam och värdelöshet vilket resulterar i ett lidande. Sjuksköterskans ansvar är att möta och lindra lidande genom ett förhållningssätt som bygger på respekt och empati. Syfte: Syftet var att belysa kvinnors upplevelser av våld i nära relationer. Metod: En kvalitativ metod valdes och en kvalitativ innehållsanalys användes för att analysera sex självbiografier. Resultat: I resultatet framkom nio kategorier med tre teman; Anpassning, Att leva under hot och Att kontrollera situationen. Slutsats: Genom kvinnors upplevelser kan sjuksköterskan få ökad kunskap angående våld i nära relationer. Förståelse för vikten av att ställa frågan angående våld och ett respektfullt bemötande var avgörande för att tillit ska skapas.
Background: Violence in close relationships mainly affects women. The normalization process causes the woman to adapt to the man, this results in isolation, feelings of shame and worthlessness which results in suffering. The nurse's responsibility is to meet and alleviate suffering through an approach that is based on respect and empathy. Purpose: The aim was to highlight women's experiences of intimate partner violence. Method: A qualitative method was chosen and a qualitative content analysis was used to analyze six autobiographies. Result: In the result, nine categories with three themes emerged; Adaptation, Living under threat and To control the situation. Conclusion: Through women's experiences, the nurse can gain more knowledge about intimate partner violence. Understanding the importance of asking the question about violence and a respectful manner was crucial to creating trust.

The overall aim of this thesis was to deepen understanding of elder abuse (EA) by exploring and comparing perceptions held by experts, older persons, representatives of potential support organizations, and family members. Experts’ perspectives (I) were examined through risk indicators and screening questions (a) located in EA literature and (b) selected by an international Delphi panel. Risk indicators most commonly found in the literature or selected by the panel were compiled into consensus lists. There were differences between risk indicators and questions in the two lists. In papers II and III participants were interviewed in focus groups about their perceptions of EA. Older persons (II) considered EA to be due to changing society and family systems where children are not brought up to respect older persons. EA was mainly conceptualized as ageism, criminal actions, mistreatment in residential care, and societal abuse. The abuser was perceived as a stranger or a healthcare worker. Fear was discussed as a major consequence of EA; especially fear among women. Abused persons were described as carrying the responsibility to seek help. Witnesses were described as hesitant to get involved. Improvements in society such as educating children and healthcare workers were considered ways to cope with EA. Besides family and friends there were few spontaneous suggestions for where to seek help and support in society. These suggestions included healthcare, police, church, and volunteer organizations. Representatives of these suggested organizations were interviewed in focus groups about their perceptions of EA (III). Perceptions of both causes and conceptions of EA were very similar to perceptions of older persons (II). Four themes emerged in the data; good intentions in abusive situations, older generation’s responsibility for EA, failing to report abuse, and prevention of abuse. Participants (III) also expressed ageist attitudes themselves and findings included victim blaming and tolerance for EA. Participants perceived that anyone could be provoked to abuse, and that abusers can be considered victims in abusive situations. Confidentiality was discussed as a barrier to reporting and the need for educating children to show respect for older persons was identified. Interviews with an adult family member (IV) explored her experiences of witnessing abuse situations between her uncle and his wife. In her desire to protect and remain loyal to her family she felt powerless and tolerated abuse. She longed for support she could trust but was locked into passivity by her feelings of shame. Synthesis of findings (I – IV) revealed issues of isolation, autonomy, vulnerability, victim blaming, perceiving the abuser as a victim of circumstances, ageism, tolerating EA, shame, and power as essential elements in EA. Based on the findings, alternative descriptions of EA are offered as a challenge to existing EA definitions. Findings suggest that a key to unlocking EA is compassion, understood as the ability to see a situation as if we were in it ourselves, experiencing the potential for disrespect, shame and unworthiness inherent in abusive acts.

Bakgrund: Livmoderhalscancer är en av de vanligaste cancerrelaterade dödsorsakerna i utvecklingsländer. Humant papillomvirus (HPV) är ett sexuellt överförbart virus som kan, vid bestående infektioner, orsaka livmoderhalscancer. I Sveriges infördes år 2010 ett vaccin till flickor som skydd mot de typer av HPV som orsakar livmoderhalscancer med 70%. I Sverige erbjuds kvinnor mellan 23 till 50 år cellprov vart tredje år, vilket minskar risken att utveckla livmoderhalscancer med 90 %. Majoriteten av kvinnorna deltar dock inte i de erbjudna cellprovskontrollerna. Eftersom HPV är ett sexuellt överförbart virus kan det hos vissa vara stigmatiserat och leda till en känsla av skam. Människans syn på den sexuella hälsan och kroppen präglas av människans kulturella bakgrund och erfarenheter vilket påverkar människans värderingar och val. Syfte: Syftet var att belysa kvinnors erfarenheter av HPV-förebyggande åtgärder. Metod: Denna studie baserades på en litteraturöversikt av elva vetenskapliga artiklar som samlades in via noggrann analys och som ligger till grund för resultatet. Dessa artiklar bestod av vetenskapliga originalartiklar som samlades in från tre olika databaser. Analysen redovisades med två huvudteman och ett undertema. Resultat: Resultat framkom i två teman; Cellprov och HPV-vaccin. Under Cellprov tillfogades ett undertema; Självtest. Resultatet visade att kvinnors erfarenheter influerades av deras kulturella bakgrund och det i sig påverkade deras attityder mot preventiva åtgärder. Det visade sig även att den kulturella bakgrunden och mödrars erfarenhet av livmoderhalscancer påverkade mödrars attityd gentemot vaccin för sina döttrar. Deltagandet av cellprovstagning påverkades av kvinnors tidigare erfarenheter och skam/skuldkänslor gällande cellprov. Kvinnors erfarenhet av självtest var positivt då det ökade integriteten och därmed minskade känslan av skam. Diskussion: Kvinnors attityd till cellprov och HPV-vaccin präglades av kunskapsbrist och kulturell påverkan. Kvinnors önskan av en mer individanpassad information både språkligt och skriftligt ansågs som ett positivt och välbehövt inslag i vården. Mer vikt bör läggas på att öka deltagandet och kunskapen hos kvinnor genom att anpassa informationen som ges ut till individen. Madeleine Leiningers teori om transkulturell omvårdnad är ett hjälpfullt stöd för sjuksköterskor att anpassa vården utifrån individens kulturella bakgrund. Det gäller både den information som lämnas och omvårdnaden av patienter.
Background: Cervical cancer is one of the most common cancer-related causes of death in developing countries. Human papillomavirus (HPV) is a sexually transmitted virus that, in case of permanent infections, causes cervical cancer. In Sweden, a vaccine for girls was introduced in 2010 to protect against the types of HPV causing 70% of cervical cancer. In Sweden, women between 23 and 50 years of age are offered cell samples every three years, which reduces the risk of developing cervical cancer by 90%. However, the majority of women do not participate in the offered cell sample checks. Because HPV is a sexually transmitted virus, it may in some cases be stigmatized and lead to a sense of shame. Human views of sexual health and the body is characterized by human cultural background and experiences, which affects human values and choices. Aim: The purpose was to highlight women's experiences of HPV prevention. Method: This study was based on a literature review of eleven scientific articles collected through careful analysis and is the basis for the outcome. These articles consisted of scientific original articles as they were collected from three different databases. The analysis was presented with two main themes and one sub theme. Results: Results emerged in two themes; Cell sample and HPV vaccine. Self-test was added as a subtheme under Cell sample. The results showed that women's experiences were influenced by their cultural background and in turn influenced their attitudes toward preventive measures. It also turned out that the cultural background and mothers' experience of cervical cancer affected mothers' attitude towards vaccines for their daughters. The participation of cell sampling was influenced by the women's previous experiences and shame/guilty feelings regarding cell samples. Women's self-test experience was positive as it increased integrity and thus reduced the sense of shame. Discussion: Women’s attitude towards Cell sample and HPV vaccine were characterized by lack of knowledge and cultural impact. Women's desire for more personalized information was considered a positive and well-needed feature in health care. More emphasis should be placed on increasing the participation and knowledge of women by adapting the information given to the individual. Madeleine Leininger's theory of transcultural care can help nurses to adapt their care based on the individual's cultural background. This applies to both the information provided and the care of patients.

Background: It´s obvious that stigma reduces life opportunities and make people act throughout an outcast role. Stigma enters spheres where it is made up to protect a group, but only results in painful feelings for the vulnerable. Individuals suffering from psychosis are exposed to discrimination because of fear and prejudices. These are applied upon individuals whereas they stigmatize themselves.  Aim: To investigate the experience of self-stigma and stigmas effects on life for patients suffering from psychosis. Method: 24 scientific articles have been used and analyzed together with Whittemore and Knalfs integrative method (2005) for the result in this literature review.   After formulating a problem literature has been searched, evaluated, and analyzed in four steps which are presented. The literature was found through databases, free searching compounds and through references. As a theoretic framework the figure Existentiell ensamhet hos personer med psykiska funktionshinder from the doctoral Berättelser om ensamhetens vardag has been used.  Results: The psychiatric contact, to be a psychiatric patient and being labeled with a psychiatric diagnosis affected the way individuals labeled themselves. Individuals wanted to be seen as unique and listened to. The diagnosis contributed to feelings of shame and affected self-esteem and self-ability. Through acceptance of the disease participants could become something different than just a patient in the psychiatric services. Through other people the participant’s self-image could be built up. Social stigmas were described in all levels of society and also within the family. Relationships were important and a link to live a normal life and recover. Normality was desirable and said to occur through activities such as work and studies. Discussion: Was discussed through relevant research and Anette Erdners figure Existentiell ensamhet hos personer med psykiska funktionshinder from the doctoral Berättelser om ensamhetens vardag.

This thesis is about nursing work and the ways in which nurses in a general hospital accomplished occupational jurisdiction. It is based on ethnographic data generated on a surgical ward and a medical ward in a single NHS trust hospital. The study is set in the context of recent developments in nursing and medical education (DHSS, 1987; GMC, 1993; UKCC, 1987) and health policy (DH, 1989) which have created the impetus for shifts in the division of labour in health care, reviving deep-rooted historical tensions between professional and service versions of nursing. Drawing on the work of Hughes (1984), Abbott (1988) and Strauss and colleagues (Strauss et al, 1963; Strauss et al, 1964; Strauss, 1978) the aim of this project was to move on from the policy debates and develop a less essentialist account of the nursing role through an exploration of the ways in which nurses managed the parameters of their work in the course of their everyday activities. Hughes concept of 'dirty work' is employed as a sensitising device. The work of hospital-based general nurses is explored through the analysis of five key nursing boundaries: nurse-doctor, nurse-support worker, nurse-patient/relative, nurse-nurse, and nurse-management. The professional and sociological literature suggested that as a result of recent policy developments, there would be an increased need for negotiation of nurses' inter-occupational boundaries with medicine and support workers and that this was likely to be subject to some tension. But field observations revealed that nurses accomplished these inter-occupational boundaries with minimal negotiation and little explicit conflict. Conversely, there were policy-related tensions at the three other key nursing boundaries - at nurses' infra-occupational boundary, at the boundary between nurses and patients and their relatives, and at the boundary between ward-based nurses and nursing and general management - which were largely unanticipated.

Aim The aim of this qualitative study was to explore Indonesian nurses’ experiences of patient education and patients’ adherence to TB treatment. Background Tuberculosis (TB) is an infectious disease that 9.6 million people in the world suffer from. Indonesia is one of the world’s 22 high-burden countries with over 320.000 cases of TB in 2014. The UN’s (United Nation) goal is to have ended the TB epidemics by the year 2030. Nurses play a central role in accomplishing adherence to treatment and prevention of TB. Method To fulfil the aim a qualitative method using semi-structured interviews was used. The interviews were recorded and transcribed. The transcribed data was analysed by using a qualitative content analysis with a manifest approach. Findings The findings, based on the result of nine interviews, showed four themes: “Strategies for patient education”, “Factors affecting patient education and adherence to treatment”, ”Outcomes of patient education” and ”Feelings and opinions about patient education”. Conclusion This study showed that the nurses use different strategies when practicing patient education. It was also shown that the nurses are well aware about patient-related factors and how they affect patient education and adherence to TB treatment. Keywords Tuberculosis, nursing care, patient education, adherence

Background: In Canada, most people die in hospital on acute medical units. Research conducted in such units has shown that dying patients often experience uncontrolled symptoms, such as pain and breathlessness. Further, hospitalized patients with end-stage disease and their family members have reported dissatisfaction with how emotional problems were addressed as well as how they were communicated with. Palliative care is understood to be the best approach to care for patients with life-threatening illness; yet, there remain constraints within the acute medical setting that make it difficult to provide such care. Aim: The purpose of this project was to better understand how cultures of care on an acute medical ward shape care practices for dying patients and what are the implications for these patients.Methodology and Methods: A focused ethnography was conducted on an acute medical ward over a period of 10 months. Data collection methods included participant-observation (600 hours over 98 visits), fieldnotes, and semi-structured interviews with patients (n = 10), family members (n = 11), and staff members (n = 14).Results: Two competing approaches to care are at play concerning dying patients: curative and palliative. This 'philosophical divide' underpins a 'logic of care' that is then used to justify the precedence of one approach to care over another. The logic of care is expressed in the following way: that limited resources (staffing, beds, equipment, and time) are in tension with ideals of good care, leading to what is perceived to be a busy environment where staff feel obliged to formulate priorities in order to meet the demands of a hectic unit. Because not every demand can be met, this logic of care is then used to privilege curative approaches to care as well as acute care tasks over palliative ones. This has repercussions for the dying patient's experience when patients' needs are not met, which further leads to patients (as well as their family members) feeling as though they do not matter. Another social process observed was the categorization of patients as curative or palliative. One of the main implications for patients categorized as palliative is that they are seen by many staff as not belonging on the medical ward. Conclusions: In the context of a curative/palliative culture clash, curative approaches and tasks are prioritized in the care provided to dying patients. Palliative care is generally perceived as limited to those with cancer at the very end of life and for those patients not requiring acute interventions. These perceptions influence the care of the dying through delaying a palliative approach to care until patients are transferred to a dedicated palliative care ward, and also through the provision of curatively-oriented end of life care. The perception that palliative or dying patients do not belong on the ward contributes to the rationale for not providing palliative care on the ward. Implications for practice could involve reflecting on how a staff focus on tasks shifts attention away from patient –or person –centered approaches to care and is potentially marginalizing to dying patients.
Historique :Au Canada, la plupart des personnes meurent à l'hôpital à des unités de soins aigus. Les recherches menées à de telles unités ont montré que certains symptômes qu'éprouvaient les patients mourants tels la douleur et l'essoufflement étaient souvent non contrôlés. De plus, les patients hospitalisés souffrant d'une maladie terminale ainsi que les membres de leur famille ont rapporté leur insatisfaction quant à la façon dont les problèmes émotionnels étaient abordés ainsi que de la façon dont on communiquait avec eux. Les soins palliatifs sont censés être la meilleure approche en matière de soins aux patients atteints d'une maladie terminale. Cependant, il subsiste des contraintes dans les milieux de soins aigus qui rendent la prestation de ce type de soins difficile. Objectif:La raison d'être de ce projet était de mieux comprendre comment les cultures de soins en présence à une unité de soins aigus façonnent les pratiques de soins prodigués aux patients mourants et quelles en sont les implications pour ces patients.Méthodologie et méthodes:Une méthodologie ethnographique concentrée a été menée à une unité de soins aigus sur une période de 10 mois. Les méthodes de collecte des données incluaient l'observation participante (600 heures sur 98 visites), les notes prises sur le terrain et des entrevues semi-structurées avec les patients (n=10), des membres de la famille (n=11) et les membres du personnel (n= 14).Résultats:Deux approches de soins divergentes entrent en jeu quand il s'agit de patients mourants : curative et palliative. Cette «division philosophique» sous-tend une «logique de soins» qui est alors utilisée pour justifier la préséance d'un type d'approche sur l'autre. La logique de soins est exprimée de la façon suivante : que des ressources limitées (personnel, lits, équipements et temps) sont difficilement conciliables avec les idéaux de bons soins, conduisant à ce qui est perçu comme étant un milieu de travail au rythme frénétique où le personnel se sent obligé d'établir des priorités afin de répondre aux demandes d'une unité surchargée. Parce que toutes les demandes ne peuvent être satisfaites, cette logique de soins est alors utilisée pour privilégier les approches de soins curatives de même que des tâches liées aux soins aigus, aux dépens de celles liées aux soins palliatifs. Ceci a des répercussions sur l'expérience vécue par le patient mourant quand ses besoins ne sont pas satisfaits, ce qui conduit alors les patients (ainsi que les membres de leur famille) à penser qu'ils ne comptent pas. Un autre processus social était la classification des patients comme curatifs ou palliatifs. L'une des principales implications de cette classification des patients comme palliatifs est que les patients mourants sont vus par de nombreux membres du personnel comme n'appartenant pas à l'unité médicale.Conclusions:Dans le cadre d'un choc culturel curatif/palliatif, les approches et les tâches curatives ont la priorité, même en matière de soins prodigués aux patients mourants. Les soins palliatifs sont généralement perçus comme limités à ceux qui souffrent d'un cancer en toute fin de vie et aux patients qui n'ont pas besoin d'interventions de type aigu. Ces perceptions influent sur les soins prodigués aux patients mourants en retardant des soins palliatifs jusqu'à ce que les patients soient transférés à une unité de soins spécifiquement palliatifs et, en prodiguant des soins de fin de vie très largement orientés vers le curatif. La perception selon laquelle les patients palliatifs ou mourants n'appartiennent pas à l'unité participe à la justification de ne pas fournir de soins palliatifs à l'unité. Les implications quant aux pratiques peuvent inclure d'axer les soins sur le patient lui-même et ses besoins par opposition à mettre l'accent sur les tâches qui sont exécutées et à réfléchir sur la façon dont ces priorités marginalisent potentiellement les patients mourants.

Introdução: O estresse ocupacional na área da Enfermagem está relacionado a fatores multidimensionais, como condições de trabalho, relacionamento interpessoal, gerenciamento do trabalho e vida pessoal, entre outros. O estresse excessivo afeta o desempenho e produtividade no trabalho e provoca disfunções e doenças. A auriculoterapia tem se mostrado como uma das práticas integrativas eficazes para o tratamento do estresse, além de apresentar custo financeiro reduzido e não necessitar de tempo prolongado para sua realização; portanto, pode ser uma técnica indicada para realização dentro do ambiente dinâmico como o ambiente hospitalar. Objetivos: Comparar a eficácia terapêutica da auriculoterapia verdadeira e sham no tratamento de estresse identificado nos enfermeiros do Hospital Beneficência Portuguesa de São Paulo Método: Responderam a ficha de dados sócio-demográficos e foram avaliados quanto ao nível de estresse pela Lista de Sintomas de Stress (LSS) e pela Escala Visual Analógica 257 enfermeiros de diferentes turnos de trabalho e setores. 168 apresentaram níveis médio e alto de estresse e foram randomizados em três grupos: Controle, Placebo e Auriculoterapia. 133 finalizaram o estudo. Os grupos Placebo e Auriculoterapia receberam 12 sessões de auriculoterapia, 2 vezes por semana. Os pontos utilizados para o Grupo Placebo foram Ouvido Externo e Área da Bochecha. Para o Grupo Auriculoterapia foram escolhidos os pontos Shen Men e Tronco Cerebral. A LSS foi aplicada no início, após 8 sessões, após 12 sessões e no follow-up de 15 dias, inclusive para o Grupo Controle. A coleta foi realizada no período de outubro de 2013 a fevereiro de 2014, após aprovação pelos Comitês de Ética em Pesquisa da EEUSP e do Hospital. Resultados: O nível de estresse prevalente em todos os turnos de trabalho foi o nível alto, com 43,58% dos participantes. Os enfermeiros com cargos administrativos apresentaram média de 59,43 de nível de estresse, enquanto os assistenciais 54,59. Quanto à evolução dos níveis de estresse, não houve diferença entre os momentos de avaliação no Grupo Controle. O Grupo Auriculoterapia apresentou diferença entre a primeira avaliação e as demais (p<0,001), ou seja, a redução dos níveis de estresse ocorreu a partir da segunda avaliação com 8 sessões. Já o Grupo Placebo apresentou diferença apenas entre a primeira e terceira avaliação após 12 sessões (p<0,001). Conclusão: Os pontos Shen Men e Tronco Cerebral foram eficazes para redução do estresse em enfermeiros com 8 sessões de auriculoterapia, 12 sessões e com follow up de 15 dias (p<0,001 em todos os momentos). Além disso, os pontos selecionados como pontos sham, Ouvido Externo e Área da Bochecha/Face, podem ser utilizados como pontos placebos em estudos de estresse.
Introduction: Occupational stress in Nursing is related to multidimensional factors, like work conditions, interpersonal relationship, work management and personal life. Excessive stress affects work productivity and performance and provokes dysfunctions and diseases. Auriculotherapy has been shown like one of effective integrative practices for stress treatment, beyond to present reduced financial cost and not to need a long time to be applicated. Therefore it can be a suggested practice to be achieved in a dynamic environment like a hospital. Obectives: To compare the therapeutic efficacy of true and sham auriculotherapy in the treatment of identified stress in nurses of Beneficência Portuguesa Hospital of São Paulo. Method: 257 nurses of different shifts and departments answered the social data demographic form and were evaluated in the stress level by List of Stress Symptoms (LSS) and Analogic Visual Scale. 168 nurses reported high and middle stress levels and were randomized in 3 groups: Control, Placebo and Auriculotherapy. 133 ended the study. The groups Placebo and Auriculotherapy received 12 sessions of auriculotherapy, twice a week. The points used for Placebo group were External Ear and Cheek area. For Auriculotherapy group were chosen the points Shen Men and Brainstem. LSS was applied in the beginning, after 8 sessions, after 12 sessions and in 15 day follow up, including for Control group. The data collection was done from October 2013 to February 2014, after approval by the Ethic Committees in Research of EEUSP and of Beneficência Portuguesa Hospital. Results: The level of stress prevalent in all the work shifts was high level with 43,58% of the participants. The nurses with administrative positions presented average of 59,43 of stress level, while assistencial position 54,59. About the evolution of stress level, there wasnt any difference among the moments of evaluation in the Control group. Auriculotherapy group performed difference among the first evaluation and the following ones (p<0,001), that is the reduction of the stress levels occurred from the second evaluation with 8 sessions. The Placebo group showed a difference only between the first and third evaluation after 12 sessions. Conclusion: The points were effective to reduce the stress in nurses with 8 sessions of auriculotherapy, 12 sessions and with 15-day follow up (p<0,001 in all the moments). Besides, the selected points like sham, External Ear and Cheek area, can be used like placebo points in stress studies.

Background: Dexcom G5, a continues glucose monitoring system, includes a follower function that gives people the possibility to see other people's glucose levels in real time. During the adolescents the metabolic control often deteriorate, When the responsibility for the diabetes care is shared between the parent and the youth there is better possibility to achieve a good metabolic control (Olinder, Nyhlin och Smider 2011). Purpose: The purpose of this study is to investigate how adolescents perceive the follower function in Dexcom G5. Method: A qualitative interview method with inductive onset. Eleven adolescents have been interviewed using a question guide with semi structured questions. The material was analysed with content analysis by Graneheim and Lundman (2014). The theoretic framework  used is person centred  care (Ekman et al., 2011). Result: The conclusion from the analysis were one theme, three categories and eight subcategories. The theme is a means of adolescents to liberation using the follower function. The categories are use of technology, safety and liberation. The adolescents had a positive perception of the follower function and they felt safe, especially during the night and when there was a risk for hypoglycaemia. They felt that their parents was safer which led to fewer diabetes related conflicts and more liberation. The adolescents felt that it was easier to get help with the self-care. Some could feel some restrictions to their integrity and they could experience some stress by being responsible for their self-care. Most did not perceive the follower function as offensive to their integrity. They could understand that their parents used it with their welfare in mind. Conclusion: The follower function can be helpful when adolescents gradually take responsibility for their self-care. It is useful both in that it makes the adolescents feel safe, but it also provides a means for parents to let go. There are times when the adolescents may feel supervised and the follower function restrict their integrity. In such cases good communication is important. This is where the diabetes nurse has an important role to play.
Bakgrund: Till Dexcom G5, en kontinuerlig glukosmätare, finns en följarfunktion som ger möjlighet att följa andras glukosvärden i realtid. Under adolescensen försämras ofta den metabola kontrollen. När ansvaret för egenvården delas mellan föräldrar och ungdomar finns det bättre förutsättningar för att god metabol kontroll uppnås (Olinder, Nyhlin och Smide 2011). Syftet: Syftet med denna studie är att undersöka ungdomars upplevelse av Dexcom G5s följarfunktion. Metod: En kvalitativ intervjumetod med induktiv ansats. Elva ungdomar har intervjuats med en frågeguide med semistrukturerade frågor. Materialet har analyserats med hjälp av innehållsanalys utifrån Graneheim och Lundman (2004). Den teoretiska referensram som använts är personcentrerad vård (Ekman et al., 2011). Resultat: Vid analysen framkom ett tema, tre kategorier och åtta subkategorier. Temat var ungdomars väg till frigörelse med hjälp av följarfunktionen, kategorierna var handhavande av teknik, trygghet och frigörelse. Ungdomarna var positiva till följarfunktionen och kände sig trygga framförallt på nätterna samt vid risk för hypoglykemier. De upplevde att deras föräldrar var tryggare, vilket ledde till färre diabetesrelaterade konflikter och en större frihet. Ungdomarna upplevde att de lättare kunde få hjälp med egenvården. Några kände sig delvis inskränkta i sin integritet, och kunde ibland uppleva det stressande att alltid ställas till svars för hur de skötte sin egenvård. De flesta upplevde dock att följarfunktionen inte var kränkande för deras integritet, de förstod oftast att föräldrarna använde sig av den med gott uppsåt. Slutsats: Följarfunktionen kan vara till hjälp för att ungdomarna successivt ska kunna ta över ansvaret för sin egenvård. Den är till nytta både för att ungdomarna ska känna sig trygga, men också för att föräldrarna ska våga släppa taget. Det fanns dock tillfällen då ungdomarna kände sig övervakade och att följarfunktionen inskränkte på deras integritet. I dessa fall framkom det att kommunikation var extra viktig. Här har diabetessjuksköterskan en viktig roll.

碩士
國立臺北護理健康大學
醫護教育暨數位學習研究所
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In recent years, the medical care model has shifted to the health care experience of medical providers and the shared decision-making model in which patients participate in each other. The Ministry of Health and Welfare began to promote the SDM practice exercise in 2017, and nursing staff is the key to the medical team. Members should have a complete concept of the formulation and implementation of shared decisions. However, if the needs of nursing staff at work are not met, psychological stress leads to mental exhaustion, which in turn affects job satisfaction. The purpose of this study is to explore the relationship between nursing staff's shared decision-making attitude and job satisfaction, and to further understand the needs of nursing staff for shared decisionmaking education and training. It is also possible to build nursing staff to share decisionrelated education and training, and to improve the sharing of decision-making attitudes among nursing staff. Professional autonomy and job satisfaction. This study adopted a cross-sectional research design, using the nursing staff to share the decision-making attitude scale and the nursing staff job satisfaction scale, and the 60 nursing staff of a teaching hospital in the North District to sample 60 people as the research object. The research data was statistically analyzed by SPSS 22.0 statistical analysis software for descriptive statistics, independent sample t-test, ANOVA and so on. The results of the study found that: (1) Nursing staff of different age groups and working years have significant differences in sharing decision-making attitudes; (2) Nursing staff with different backgrounds did not reach significant differences in job satisfaction; (3) The shared decision-making attitude is significantly positively correlated with the job satisfaction. It is hoped that through the discussion of the results of this study, medical institutions will be encouraged to build a nursing staff to share decision-related education and training, and to improve the sharing of decision-making attitude, professional autonomy and job satisfaction among nursing staff. In the future, it can be applied to the promotion of clinical medical and disease sharing decisions. Improve the quality of overall health care.