Bakgrund: Sverige har under åren utvecklats till ett multikulturellt land vilket innebär att nyexaminerade sjuksköterskor kommer att möta patienter från olika kulturella bakgrunder. Detta examensarbete kan användas som stöd för grundutbildade sjuksköterskor då det belyser hur andra sjuksköterskor har hanterat svårigheterna och utmaningarna som kan uppstå vid omvårdnad av palliativa patienter från olika kulturella bakgrunder.

Syfte Syftet med arbetet är att beskriva grundutbildade sjuksköterskors upplevelser av transkulturell omvårdnad inom palliativ vård.

Metod: Metasyntes användes som analysmetod för arbetet. Det är skrivet utifrån en kvalitativ litteraturöversikt och är baserad på totalt 10 kvalitativa artiklar.

Resultat: Resultatet för detta arbete valdes att presenteras utifrån tre huvudteman samt åtta subteman. Tema ett (1): Det som krävs för möjligheten till en god kommunikation vid transkulturell omvårdnad med tre (3) subteman: Verbal kommunikation, Beröring som kommunikationssätt samt Hjälp av tolk. Tema två (2): Kulturella skillnader med tre (3) subteman: Oro över att kränka patienten, Vikten av kunskap om kulturella skillnader samt Etiska dilemman. Tema tre (3): Sammarbete med familjen för personcentrerad vård med två (2) subteman: Medvetenhet om patienten som individ ochFamilj över autonomi

Slutsats: De grundutbildade sjuksköterskorna upplevde den verbala och icke-verbala kommunikationen som en svårighet vid transkulturell vård av palliativa patienter. Användning av tolk upplevdes inte alltid som positivt, och att ha kunskap om olika kulturer för att kunna ge personcentrerad omvårdnad sågs som viktigt.

Objectives: The aim of this study was to establish the top 10 research uncertainties in aortic dissection together with the patient organization Aortic Dissection Association Scandinavia using the James Lind Alliance concept. Methods: A pilot survey aiming to identify uncertainties sent to 12 patients was found to have high content validity (scale content validity index = 0.91). An online version of the survey was thereafter sent to 30 patients in Aortic Dissection Association Scandinavia and 45 caregivers in the field of aortic dissection. Research uncertainties of aortic dissection were gathered, collated and processed. Results: Together with research priorities retrieved from five different current guidelines, 94 uncertainties were expressed. A shortlist of 24 uncertainties remained after processing for the final workshop. After the priority-setting process, using facilitated group format technique, the ranked final top 10 research uncertainties included diagnostic tests for aortic dissection; patient information and care continuity; quality of life; endovascular and medical treatment; surgical complications; rehabilitation; psychological consequences; self-care; and how to improve prognosis. Conclusion: These ranked top 10 important research priorities may be used to justify specific research in aortic dissection and to inform healthcare research funding decisions.

The inclusion of family members in the acute care of older persons with complex needs results in better coordination of care and reduces the frequency and/or duration of rehospitalisation. Therefore, healthcare professionals need a tool to assess the collaboration with family members on acute hospital wards. The aims were to test the psychometric properties of the Swedish version of the Family Collaboration Scale (FCS), to investigate family members' perception of collaboration with healthcare professionals on acute medical wards in Sweden and to compare the data with the corresponding Danish results. Three hundred and sixty family members of frail patients aged 65 or older from 13 acute medical wards answered the FCS questionnaire. In addition to descriptive statistics, psychometric methods were applied. The internal consistency of the Swedish version of the FCS was excellent, and confirmatory factor analysis revealed that its factor structure was equivalent to that of the original Danish FCS. The respondents' ratings indicated better perceived collaboration than in the Danish case. Older age than 60 was associated with worse collaboration with healthcare professionals regarding Influence on discharge than younger respondents. Those with compulsory and health or nursing education showed better collaboration. The Swedish version of the FCS should be further evaluated for its retest reliability and as an outcome measure in intervention studies.

Background: Previous research shows that female patients may feel uncomfortable when nursing is performed by male nurses. Probable explanations for this are the male nurse's special position as a minority in health care. Furthermore, the role of caring for and nurturing has not always been an attribute commonly ascribed to men. Purpose: Therefore, this study aims to identify how male nurses and nursing students experience the practice of nursing measures when the patient is a woman. Method: The present study has been designed as a literature review based on 11 articles with a qualitative approach that were analyzed based on the method of metasynthesis. Result: During the analysis, four themes could be identified: "Intimate care", "Touch", "Religious and cultural barriers", "Strategies". Conclusion: The mapping shows that male nurses encounter problems due to their gender. Problems that in turn cause anxiety and stress in different nursing situations which can have a direct impact on the care they provide to patients of the opposite sex. Furthermore, it can affect which specialization the male nurse chooses after completing the education.

PURPOSE: To describe perceptions of the transition from receiving the diagnosis recessive limb-girdle muscular dystrophy to becoming in need of human support to manage daily life and using a wheelchair for ambulation, from the affected young adults' and their parents' perspectives. METHOD: A qualitative and descriptive study design was used. Semi-structured interviews were held with 14 young adults diagnosed with recessive limb-girdle muscular dystrophy and 19 parents. Phenomenography was used for data analysis. RESULTS: The diagnosis was described as being a shock and difficult to comprehend but also as a relief and a tool for information. Beginning to use a wheelchair was perceived to be mentally difficult but it also provided freedom. New ways of living involved physical, emotional, practical, and social difficulties as well as experiences of learning to adapt to the disease. The transition was overshadowed by concern about disease progression and influenced by facilitating factors, which were young adult being seen as a person; supportive family and friends; mobilized internal resources; meaningful daily activities; adapted environment; and professional support. CONCLUSIONS: The different perceptions expressed in this study highlight the importance of identifying personal perceptions and needs in order to optimize support provided by healthcare professionals. Implications for Rehabilitation The different perceptions described in this study emphasize the need for person-centered care for young adults living with recessive limb-girdle muscular dystrophy and their parents. Regular controls and professional support to cope with the disease and its consequences should be offered, not only at the time of diagnosis but also throughout disease progression. Beginning to use a wheelchair can be a psychologically distressing process, which has to be acknowledged by healthcare professionals when introducing it. Healthcare professionals should not only recognize the importance of having social relations and activities that are meaningful but also be a link to authorities in society and to interest organizations that can help to facilitate the person's management of the disease.

Volt hockey is a team sport developed for persons with physical disabilities, but its influence on well-being is unknown. Elements of well-being have been described as positive emotions, engagement, relationships, meaning, and achievement constituting a theoretical framework referred to as PERMA. The purpose of this study was to describe how well-being according to PERMA is reflected in the experiences of playing volt hockey. Data were collected through focus group and individual interviews including 21 players. A deductive analysis was conducted using the elements in PERMA as preexisting main categories with an additional main category, named resources needed. Findings showed that all five elements constituting well-being according to PERMA were reflected in the experiences of playing volt hockey. In addition, players emphasized the importance of having the resources needed to play volt hockey. In conclusion, having the opportunity to enjoy playing volt hockey enabled the players to flourish and experience feelings of subjective well-being.

Background: Nurses care for patients countinuely and create relationships with patients and relatives. To provide good care requires firstly, professional knowledge in the form of subject knowledge, personal skills, values ​​and ethics. Secondly, more generic competencies are required that are common to everyone in the team, called core competencies. Palliative care involves improving the patient's quality of life by relieving symptoms. It neither accelerates nor postpones death, but it integrates psychological and spiritual aspects of patient care. Palliative care means that you try to achieve the best possible palliative treatment with commitment and care.

Aim: The aim of this literature study was to shed light on the nurse's experiences and experiences of palliative care. Method: A systematic literature review was conducted to answer the purpose of a qualitative study design. PubMed and CINAHL were used for database searches. 15 articles were selected, of which 10 of these articles were used in the results section. Results: In the results section, the nurses' experiences of palliative care and their experiences of communication with patients, relatives and care staff emerged. In addition, the nurses' experiences of the medical equipment as well as support and cooperation emerged. Conclusion The nurses expressed different emotional experiences of palliative care. The nurses became emotionally involved when caring for the dying patients, especially when they had cared for the patients for a long time and when they had gotten to know the patient and the family. The nurses considered that lack of time was an obstacle to listening and communicating with the patients. Some nurses felt proud of their work and they thought it was a unique opportunity to be involved in the patients' last days in life.

Background: Approximately 75% of all women of childbearing age are affected by premenstrual symptoms. 15–20% have more distinct PMS, while 2–5% suffer from the more severe version PMDD. The most common symptoms are anger, irritability, anxiety, increased bloating, soreness in the breasts, headaches, joint/muscle pain and weight gain. Aim: The aim of the literature study was to investigate women's experiences of living with PMS and PMDD. Method: The thesis was carried out as a literature study with a qualitative study design. Ten scientific articles were compiled in order to answer the aim of the study. Results: For some women, PMS can mean years of monthly suffering, for others it's a sign of being a healthy woman. Women witnessed having to resort to different coping strategies to make everyday life work, the most common were personal time and self-monitoring. Many women experienced a negative societal image of PMS and how the premenstrual woman was perceived, these norms and ideals have been shown to have a harmful impact on their self-image and how they experience their premenstrual distress. Jean Watson (1985) highlights the importance of the nurse instilling faith and hope in the patient before the situation they find themselves in. In this way, the nurse can contribute to behavioral and attitudinal changes. Conclusion: Women feel that there is a societal ignorance that affects the extent to which they are comfortable speaking about their distress. This means that women do not receive the support and help they need to cope with everyday life, something that has a direct impact on their quality of life. Increased awareness and knowledge is fundamental in order for the nurse to provide adequate and person centered care for these women. 

Bakgrund: Centralvenös kateter (CVK) är en kärlaccess och livräddande instrument som har blivit en vanlig företeelse på vårdavdelningar och hemsjukvården inte bara på intensivvårdsavdelningar. Endast personal som är väl förtrogna med uppgiften får handha hanteringen av katetern. Vårdrelaterade infektioner är ett stort problem inom dagens sjukvård och medför såväl ökade vårdtider som ökade kostnader och med CVK följer risker för infektioner, både lokala och systemiska. Sjuksköterskans förebyggande arbete är därmed en nyckelroll i att förebygga infektioner relaterade till CVK samt öka patientsäkerheten. Syfte: Syftet med litteraturstudien är att undersöka sjuksköterskans kunskapsnivå om vilka åtgärder som förebygger infektioner relaterat till CVK hantering. Metod: En allmän litteraturstudie valdes. Databassökningar utfördes i Cinahl och PubMed. Efter kvalitetsgranskning inkluderades tio vetenskapliga artiklar med kvantitativ metod. Resultat: Hanteringen av CVK i förebyggande syfte till VRI sorterades in under tre teman: utbildning, hantering av praktiska åtgärder och följsamhet av riktlinjer. Åtgärderna inom dessa teman visade sig minska förekomsten av CVK- relaterad infektion. Konklusion: Personalutbildning, omläggningsteknik, läkemedelsadministrering, CVK uppföljning och utvärdering samt följsamhet för CVK protokollet är åtgärder som sjuksköterskan behöver ha kunskap om för att kunna förebygga kateterrelaterade infektioner hos patienter med CVK. Det krävs mer forskning gällande vikten av CVK hantering för att kunna skapa tydligare riktlinjer som bidrar för mer aktsamhet och minskning av VRI.

Background: Healthcare-related infections (VRIs) compose a global patient safety risk. One third of all healthcare injuries in Sweden are healthcare-related infections. The most common VRI are urinary tract infections (UTI) and postoperative wound infections of varying severity, which account for about 50% of all VRIs in Sweden. The hands are the largest source of infection for diseases in health care and therefore it is important that the registered nurse works preventively and follows hand hygiene routines to reduce the risk of infections in health care. Aim: The purpose of this literature study is to describe the undergraduate nurses' experience of adherence to basic hygiene routines in inpatient care with a focus on hand hygiene. Method: This literature study used 10 qualitative scientific articles. The articles were taken from two databases PubMed and CINAHL focusing on nurses. Articles reviewed according to SBU guidelines and were analyzed to identify relevant articles that serve the aims of the study. Results: The results of the study have been compiled into four headings. The four headings were: knowledge and skills deficiencies, environmental and organizational factors, attitudes and social behavior technology. Conclusion: Nurses think that there is a shortage of hand hygiene products, staff and knowledge, which has a negative impact on compliance to hand hygiene.

Background: Sweden is today a multicultural society with a population where some have a mother tongue other than the official language. Among other things, this has led to language barriers arising, especially in healthcare. Aim: The aim of the study was to illustrate the nurse's experience of cross-cultural communication. Method: A literature review based on nine scientific articles with a qualitative approach and one with a mixed method. Results: The ten selected scientific articles answered the purpose of the literature study. The results were presented in six main themes: impact on the quality of care, the relationship between nurse and patient, communication without speaking the same language, bilingual nurses as interpreters, relatives as interpreters, and professional interpreters. The lack of communication between the nurse and the patient led to a lack of participation for the patient as the patient avoided communicating with the nurse and did not understand much of the information provided. Bilingual nurses had to often act as interpreters despite the lack of training in this area. Conclusion: The study shows that language barriers complicated the nurse's work and as a consequence also made the workaround nursing and patient-safe care more difficult. Both the nurse and the patient were affected by the language barriers that arose. One solution could therefore be for the nurse to expand her knowledge in communication to offer the patient safe care.

Background: Covid-19 is an ongoing pandemic since the end of 2019. The virus has spread throughout the world. The lack of planning, resources and leadership has been an enormous problem during the pandemic. This has led to stress and pressure in the health care for the society. The nurses have been suffering physical and mental problems because of Covid-19.

Aim: The purpose of this literature study was to describe nurses' experiences of caring for patients with Covid-19.

Method: Only qualitative studies were used in the literature study. CINAHL, Psycinfo and PubMed were used as databases for data collection. With the help of inclusion and exclusion criteria, thirteen studies were found and selected for the result of the literature study. Each study that was found was assessed for quality which resulted in nine high quality studies and four medium quality studies.

Results: Two themes were found, and each theme had its own subthemes. The themes were “Physical and mental challenges” as well as “Experiences of the organization”.

Conclusion: The results showed that nurses who cared for patients with Covid-19 experienced negative emotions, experienced physical and mental challenges in relation to performing various nursing work. The nurses obtained experience and an extended knowledge around various nursing work, which was a positive experience for the nurses. Some nurses experienced a lack of support from the organizations and the government as well as a lack of clear guidelines and information regarding performing safe and person-centered care. After working together for a while, the nurses experienced a better team spirit as well as support from the society.

Keywords: Covid-19, Experiences, Nurse, Nursing, Pandemic.

Bakgrund: Multipel skleros är en kronisk och allvarlig sjukdom som successivtleder till fysisk funktionsnedsättning. Sjukdomen uppstår på grund avinflammation i det centrala nervsystemet. Det är den vanligaste orsaken tillrörelsehinder i Sverige. Orsaken är okänd och det finns inget botemedel. Studiervisar att behandlingen av MS är främst inriktad på symtomlindring. Det var därförbetydelsefullt att belysa personers upplevelser av att leva med MS för att kunnaförstå hur de uppfattar sjukdomen. Detta kan leda till en förbättrad ochpersoncentrerad vård där deras perspektiv är i centrum. Syfte med studien var attbelysa personer med MS och deras upplevelser av att leva med sin sjukdomMetod: En litteraturstudie baserad på elva studier med kvalitativ ansatsgenomfördes och data analyserades med innehållsanalys. Resultat: Tre temanidentifierades som var fysiska och psykisk påverkan, att hitta copingstrategier ochpåverkat socialt liv. De flesta av personerna blev fysisk begränsade i derasförmåga till rörlighet men även emotionellt påverkade. Självbilden blev påverkadoch kroppen kändes främmande. Familjeroller förändrades där majoriteten kändesig misslyckade i sina tidigare roller. Personerna upplevde att andra människorinte förstod sjukdomen och hade fördomar om den sjuka individen. På grund avbegränsningar blev det av vikt att planera vardagen för att orka och spara energi.De flesta fann hopp och var villiga att acceptera sjukdomen samt lära sig att levamed det. Konklusion: Symtom på MS varierar mycket och är känd för sinoförutsägbarhet. Det är viktigt som sjuksköterska att kunna identifiera personernasbehov av vård på ett personscentrerat sätt.

Bakgrund: Ungefär en tredjedel av de patienter som söker vård inom primärvården gör det på grund av psykisk ohälsa. Det är av vikt att primärvården är anpassad och bemannad för att hantera psykisk ohälsa eftersom primärvården ska vara ingången för all typ av ohälsa i befolkningen. Tidigare studier visar att sjuksköterskor i primärvården upplever en kunskapsbrist i psykiatri som kan riskera att bemötandet av patienter med psykisk ohälsa blir stigmatiserande. Rekryteringen av specialistsjuksköterskor i psykiatrisk vård i primärvården ter sig som en relativt ny företeelse. Det finns inga svenska studier som beskriver deras roll och funktion på vårdcentral eller deras upplevelse av arbetet i primärvård. Syfte: Att undersöka erfarenheterna hos specialistsjuksköterskor i psykiatrisk vård av arbetet på vårdcentral med patienter som söker vård för psykisk ohälsa. Metod: Specialistsjuksköterskor i psykiatrisk vård (N=11) vid nio vårdcentraler i Region Skånes regi intervjuades med semistrukturerade intervjuer. Dataanalysen genomfördes med kvalitativ innehållsanalys enligt Graneheim och Lundman (2004). Resultat: Analysen resulterade i fem kategorier: mötet med patienten med psykisk ohälsa, arbetar självständigt, värdesätter teamarbete, samverkar med specialistpsykiatrin, och besitter värdefull kompetens. Det latenta innehållet i kategorierna formulerades i temat “Unik roll där specialistkompetensen används”. Konklusion: De allra flesta intervjuade specialistsjuksköterskorna i psykiatrisk vård upplevde att de använde sin specialistkompetens i stor utsträckning och att det fanns ett stort behov av deras kompetens. De beskrev en mycket självständig roll med stort eget ansvar. Betydelsen av lång och bred erfarenhet, utöver specialistutbildningen och kunskap i samtalsmetodik, betonades.       

Background: Dementia is a chronic public disease that affects millions of people around the world. The disease causes severe cognitive impairment in, among other things, the ability to speak, the ability to act and the ability to communicate. People with dementia suffer from obstacles in their ability to communicate, both verbal and non-verbal communication, which leads to people having challenges in expressing themselves and taking in information from the environment. Impaired communication skills can challenge and affect nurses' main task, which is person-centered nursing. Aim: The aim of the study is to compile nurses' experience of communication with people with dementia. Method: The literature study was conducted with ten qualitative scientific articles. The articles were retrieved from two databases, Cinahl and PubMed, and have been reviewed based on SBU's quality review template. Result: Three main themes and five sub-themes are presented to answer the purpose of the study. The three main themes were Nurses' experiences of communication with patients with dementia, Adapted communication for people with dementia, Common language in the nurse-patient meeting. The results were then divided into four sub-themes: Body language, facial expressions and body contact, clear and clear communication, A white lie, the impact of the health care environment on communication and Mother tongue. Conclusion: Communication is thus central to being able to care for patients with dementia. It is the job of nurses to carry out nursing care, where communication plays a crucial role in the care of people with dementia.

Alm, A & Eborn, S. Nurses’ experiences of caring for people with mental illness in somatic departments. A literature review. Degree Project in nursing 15 credit points, Malmö University: Faculty of Health and Society, Department of Care Science, 2023. Background: Since the mid-90s, the number of full-day psychiatric places has decreased sharply, which has resulted in more and more patients with mental illness seeking and being cared for in somatic wards. The nurses who work in the somatic departments are expected to use a person-centred approach to provide the best care possible. Aim: The aim is to highlight how nurses who work in somatic care experience the care of patients with mental illness. Method:A literature study based on 12 scientific articles with a qualitative approach. The databases Cinahl, PubMed and PsycInfo have been used for obtaining material. The analysis has been carried out according to Popenoe et al.'s systematic method for data analysis. The articles have been quality reviewed according to SBU's review template. Results: The following six categories were identified: 1) Limited care environment 2) The importance of support and cooperation 3) A time-consuming patient group 4) Experiences of inadequacy in care 5) The importance of communication 6) Try to meet the nursing need.Conclusion: The nurses felt that patients with mental illness are a resource-demanding patient group, which resulted in the nurses feeling the need to provide more care to them than the other somatic patients. The nurses also felt that the patients were using the system to their advantage, which resulted in a reluctance to care for the patients more than what was absolutely necessary.

Background: Overweight and obesity are considered one of the biggesthealth problems of our time. Despite existing guidelines for preventive work, the increase continues and today affects more than 1.9 billion people worldwide, and entails an increased risk of developing sequelae such as diabetes, cancer and cardiovascular disease. The nurse has a central role in the nursing care, and the prevalence of the disease means that the registered nurse can meet this group of patients in different instances in the care chain. Aim: The purpose of the literature review was to illustrate the nurses' experiences of caring for overweight and obese adults with focus on promoting health. Method: The study was conducted as a literature review with a qualitative approach. With the databases Cinahl and Pubmed, twelve scientific articles were generated which were used to answer the purpose of the study in the result. Selected studies were reviewed using the SBU's review template and analyzed using metasynthesis. Result: The result highlighted the factors that influenced the nurse's work with the patient group. The factors led to the identification of three main themes: organization and collaboration in teams, knowledge and education, as well as attitudes and treatment. Based on the three main themes, another seven sub-themes could be identified, which enabled a deeper insight into how the nursing care was affected. Conclusion: Overweight and obesity are a complex health condition that can be caused by several different aspects. The complexity can result in that the nurse's knowledge is not sufficient, which places demands on well-functioning transcendence work between different professions. Attitudes and prejudices have a negative impact on the work, which leads to poorer care and increases the workload. More resources in the form of time, materials, training and guidelines are needed for the nurses to be able to offer good care to the group of patients.

Bakgrund: Årligen i Sverige uppskattas tio procent av patienterna drabbas av vårdskada. Inom hälso- och sjukvården är resursbrist och hög arbetsbelastning vanligt förekommande samtidigt som sjuksköterskan befinner sig i en arbetsmiljö med krav på att upprätthålla patientsäkerheten. Det är av vikt att den grundutbildade sjuksköterskan har förståelse för på vilket sätt arbetsmiljön påverkar patientsäkerheten för att kunna bedriva säker vård som tillgodoser patientens grundläggande behov. Syfte: Studiens syfte var att belysa hur sjuksköterskan erfar att arbetsmiljön påverkar patientsäkerheten.Metod: Litteraturstudien bygger på tolv vetenskapliga artiklar med kvalitativ ansats. Artiklarna är hämtade från databaserna Cinahl, PubMed och Psykinfo. Analysen har utgått från innehållsanalys och artiklarna har kvalitetsgranskats. Resultat: Fyra teman identifierades: Organisation och ledning, Fysisk och Psykisk påverkan, Bemanning och arbetsbelastning samt Teamarbete och kommunikation.Konklusion: Studien lyfter flera olika faktorer i sjuksköterskans arbetsmiljö som påverkar patientsäkerheten. Utmärkande var framförallt personalbrist och hög arbetsbelastning, vidare betonas att god kommunikation och fungerande teamarbete har positiv påverkan som bidrar till att sjuksköterskan kan tillgodose patientens grundläggande behov. För att förbättra sjuksköterskans arbetsmiljö och upprätthålla god och säker vård krävs åtgärder på såväl organisatorisk nivå som på individnivå. Litteraturstudien genererar en ökad förståelse för arbetsmiljöns betydelse för såväl sjuksköterskans personliga hälsa som patientens säkerhet. 

Background The number of people diagnosed with ADHD has increased steadily over the past 15 years. It has been shown that many have been diagnosed first as an adult. In recent years, research has shown the experience of a lower quality of life in adults with ADHD as well as several consequences of untreated ADHD such as divorce, increased risk of addiction, car accidents, accidental injuries, depression, anxiety, and suicide.

Aim The aim of the literature study was to compile experiences of ADHD in people who received the diagnosis in adulthood.

Method Literature review with qualitative design. Based on the perspective of adults with ADHD, a total of ten scientific articles from the PsycInfo and Cinahl databases were reviewed. Data were extracted, translated, condensed, coded and thematized based on basic content analysis.

Results The analysis of the results of the studies resulted in three main themes: ADHD affected life which describes the impact of ADHD, The significance of the diagnosis and the winding road talks about thoughts and feelings of being diagnosed, and Experiences of strategy, care and treatment which depicts the coping strategies of symptoms and difficulties as well as experiences of offered care.

Conclusion Experiences of symptoms and difficulties related to ADHD can differ greatly between people and gender. Something that has to be understood in order to enable work based on person-centred care. Stigma and negative experiences of healthcare are seen to be caused by lack of understanding and unawareness. Why the importance of attitude change in society is seen as crucial for good quality of life and to be treated well. One knowledge gap that was seen was women's experience of the cause of later diagnosis, here continued research is needed.

Background: Breast cancer is an important and relevant topic for the registered nurse as it is part of the nurse’s professionalism to care for and support women with a diagnosed illness. Aim: The aim was to highlight women’s experiences upon receiving a breast cancer diagnosis. Method: To fulfill the purpose, a qualitative review was conducted. All articles used as the basis for the literature review were retrieved from the databases CINAHL and PubMed. The analysis of the articles was based on Popenoe’s analysis model. Quality assessment of the articles was performed according to the template of the Swedish Agency for Health Technology Assesment of Social Services. Result: The study identified three categories with the first one labelled as ”Emotional reactions” and consisting of the following three subcategories: Initial reactions, Thoughts about death and Feeling like a burden. The second main category:” Uncertainty about the future” included the following two subcategories: Concerns about treatment and Losing one’s role as a woman. The last main category:” The significance of support”, led to two subcategories: Support from others and Support from healthcare professionals. Conclusion: Receiving a breast cancer diagnosis can be a traumatic experience for many women and can have an impact on their physical, mental and social well-being. Every woman experiences a breast cancer diagnosis in different ways and will react differently. The support from healthcare professionals was found to be perceived differently, highlighting the need for individual support. 

Background: A dysfunctional use of coping strategies has repeatedly been linked to suicidal behaviour in non-psychiatric populations. However, data regarding association between coping strategies and suicidal behaviour in psychiatric populations are limited. Aims: The aim of the study was to investigate the possible relationship between self-reported suicide risk, suicidal ideation and coping strategies in three psychiatric cohorts. Method: Three cohorts of psychiatric patients were involved in the study; recent suicide attempters (n = 55), suicide attempters at follow-up 12 years after a suicide attempt (n = 38) and patients with ongoing depression without attempted suicide (n = 72). Patients filled in the self-rating version of The Suicide Assessment Scale (SUAS-S) from which items no. 17–20 addressing current suicidal ideation were extracted. To investigate coping strategies, the Coping Orientation of Problem Experience Inventory (COPE) was used. Results: In all cohorts, regression analyses showed that only avoidant coping was significantly correlated with the scores of SUAS-S adjusted for covariates. The items no. 17–20 correlated significantly to avoidant coping but not with other coping strategies in all cohorts. Conclusion: The results of this study indicate that among coping strategies only avoidant coping may be associated with suicide risk in psychiatric patients independently of history of attempted suicide.

Background: A pressure ulcer is an injury to the skin and underlying tissue that can occur after pressure or shear. Patients who suffer from pressure ulcers express that it causes great physical, psychological and social suffering. The nurse is responsible for the nursing work where pressure ulcer prevention is part of the preventive work and includes risk assessment, skin assessment and regular repositioning. Aim: The aim of the literature study was to shed light on nurses' experiences of pressure ulcer prevention in inpatient care. Method: Qualitative literature study based on 10 articles with a qualitative study design obtained from the databases Cinahl and Pubmed. The results of the selected articles were analyzed by conventional content analysis. Result: Through the content analysis, main categories and subcategories were crystallized from the results of the articles. The result was formed into two main categories: Care team and Work environment and six subcategories: Prevention, Communication, Nurse, Patient, Organizational factors and High workload. Conclusion: Nurses had experience that the care team and the caregiver's organizational responsibility had a decisive importance in the work with pressure ulcer prevention.

Background: Being constipated means physical and mental suffering that negatively affects the quality of life. Impaired fluid intake, low-fiber diet, immobilization, illness and medication are risk factors for constipation. Old age and female gender mean a further increased risk of being affected. The most common treatment methods for constipation are laxatives which can be difficult to balance as well as the invasive treatments enema and manual evacuation which for the elderly can be experienced as very stressful. Aim: The aim of the literature study was to shed light on non-invasive nursing measures for patients with constipation living in nursing homes aged 65 years and older. Method: This study was conducted as a literature review with a quantitative approach. Ten scientific articles were selected of which four were randomized trials and six were non-randomized trials. The studies underwent a quality review in which five articles were graded as grade I, which refers to high study quality, and five as grade II, which refers to medium-high study quality. Using the analysis, four themes were identified; healthy bacteria as a nursing measure, dietary supplements as a nursing measure, external influences as a nursing measure and individualized nursing measures which structured the results. Results: Nursing measures in the form of healthy bacteria, dietary supplements, external influences and individualized nursing resulted in a good therapeutic effect against constipation. Constipation-related symptoms decreased, quality of life improved and administration of laxatives, enemas and manual evacuation were reduced. Conclusion: The results of the literature review showed that non-invasive nursing measures exists that nurses can implement to treat constipation in nursing homes in Sweden. The nursing measures require acceptance, time and willingness from both patient and nursing staff for implementation.

Background: Nurses face many challenges in the nursing profession. One challenge is the ability to handle patient trauma and at the same time, as a nurse, process their trauma. With more awareness about how secondary traumatic stress shows itself in nurses and its aftermath, the stress can be identified in earlier stages. Aim: The aim of this literature review is to map how the aftermath of secondary traumatic stress show itself in nurses, described by nurses. Method: This study has been designed as a qualitative literature review with searches carried out in the databases CINAHL and PubMed. The mapping resulted in ten articles that were reviewed for their quality. Result: The metasynthesis of the identified articles resulted in seven subthemes, desire to leave nursing, providing insufficient care, teamwork, depersonalization, emotional distress, lack of resources and knowledge deficit. Conclusion: When the secondary traumatic stress overpowers the nurse, it may result in the nurse leaving its profession. Future research should thereby focus on methods that support the nurses exposed to secondary traumatic stress and lessen their feeling of exhaustion. Methods that help not only the nurses but also the patients they care for.

This study aimed to provide an understanding of nursing students’ self-reported eHealth literacy in Sweden and Poland. This cross-sectional multicentre study collected data via a questionnaire in three universities in Sweden and Poland. Descriptive statistics, the Spearman’s Rank Correlation Coefficient, Mann–Whitney U, and Kruskal–Wallis tests were used to analyse different data types. Age (in the Polish sample), semester, perceived computer or laptop skills, and frequency of health-related Internet searches were associated with eHealth literacy. No gender differences were evidenced in regard to the eHealth literacy. Regarding attitudes about eHealth, students generally agreed on the importance of eHealth and technical aspects of their education. The importance of integrating eHealth literacy skills in the curricula and the need to encourage the improvement of these skills for both students and personnel are highlighted, as is the importance of identifying students with lacking computer skills.

Background: It is a common problem in healthcare that patients do not take prescribed medication. This can have major consequences for the patients. It is important to investigate what nurses really know about the causes of patients' lack of adherence, as a correct understanding of the phenomenon means that the nurse can help the patient in the best way.Aim: The aim of the literature study was to compile nurses 'experiences of patients' non-compliance with prescribed drug treatment.Method: The essay is based on a literature study with a qualitative approach.Included studies were sought in the databases PubMed and CINAHL. A quality review, of relevant studies, was made based on SBU's quality review template. A content analysis was made of the articles, based on Forsberg and Wengström. A total of 10 articles were used in the present literature study.Results: The results showed that nurses largely explain patients' non-adherence with three main categories of causes: Patient-specific causes, causes in thepatient's environment and the relationship between the patient and the nurse.Conclusion: Nurses have a good idea of the causes of patients' difficulties or unwillingness to use prescribed medication. However, nurses attribute certain causal relationships to be more important than what other, patient-centeredresearch has shown. More research is needed to clarify the degree of nurses'insight into the problems of patients.

Background: Telenursing within eHealth is a growing phenomenon due to an increase in aging within the population and changes in demographics. Telenursing within primary health care is the first line for patients to get support and help. Good communication and how the patient is approached by the nurse is of importance in the call due to lack of visual cues. Furthermore, the nurse must assign to person-centred care, which is one of the nurses’ core competencies. How is the nurse-patient relation affected due to physical meetings being carried out to a lesser extent? Aim: The aim is to compile nurses' experiences of factors with an impact on nurse-patient relations in telenursing within primary health care. Method: Literature review with an inductive approach, based on ten qualitative studies, published between 2001–2020. To process the data content analysis was used. Results: Three categories of importance for nurse-patient relations were identified during the analysis: the conversation, the assessment and decisionmaking process and the organization. The findings were overlapping in many aspects. Difficulty linked to the lack of visual cues was a distinctive result, which pervades all three main findings. Furthermore, difficulties regarding the organization and the lack of resources, were related to both the conversation and the assessment and decision-making process. Conclusion: The absence of visual cues which emerged in the result is an important aspect of the assessment, which can affect the assessment negatively. Organizational shortcomings with the effect of the nurse having to make decisions quickly can result in the person-centred care being opted out, which affects the nurse-patient relations. The results of the literature review can increase the understanding of the nurse's experiences of nurse-patient relations in telenursing within primary health care. More research within the topic is of interest to ensure that good quality of care is provided, due to an estimated increase of demand on primary health care in the future.

Background: Compassion fatigue is a combination of fatigue and secondary traumatic stress which brings with it a lack or loss of empathic abilities, as a way to protect the individual's own wellbeing. The prevalence of compassion fatigue is on the rise as well as the consequences it has on nursing.Aim: The purpose of the study was to compile literature that described nurses' experiences of empathy fatigue. Method: A qualitative approach was used, and the data consisted of ten qualitative studies based on descriptions from nurses in various nursing contexts to highlight nurses’ experiences of compassion fatigue. Result: The result of the literature review discovered two main categories: Experienced losses caused by compassion fatigue and Perceived lessons learned by compassion fatigue. The findings show that the majority of nurses' experiences present themselves as losses related to compassion fatigue.Conclusion: Compassion fatigue is a multifaceted phenomenon which affects the nurse on several levels. In the end, it leads to inadequate care of patients. Furthermore, to avoid compassion fatigue, more resources are required such as additional nurses, added time for reflection and increased support from management and organization to ensure a sustainable career for the nurse and adequate care for the patients. 

Little is known about operating theatre nurses’ (OTNs) main concerns during the perioperative organ donation process. The purpose of this study was to explore OTNs’ experiences of caring for the organ donor during operations where organs are retrieved and to answer the question: what is the main concern during this procedure and how do they deal with it? A total of ten OTNs, one man and nine women with a mean age of 51.8 years (range 38-63 years) were interviewed in this Constructive Grounded Theory study. A core category emerged: Optimum organ retrieval, where the generated grounded theory is present in the four main categories: Brace oneself, Facilitate, Retrieve and Completion. Commitment is the force that binds the OTN to a course of action of relevance for optimum organ retrieval. Respect for and the dignity of the donor are essential. 

Bakgrund: Inflammatorisk mag-tarmsjukdom är ett samlingsnamn för Ulcerös kolit och Crohns sjukdom. Gemensamt för sjukdomarna är att de är kroniska och att de går i skov, vilket innebär att sjukdomen är mer aktiv i vissa perioder och mindre aktiv under andra. Inflammatorisk mag-tarmsjukdom påverkar patienterna fysiskt, psykiskt och socialt, vilket påverkar deras livskvalitet. Inflammatoriska mag-tarmsjukdomar kan resultera i psykiska besvär, därför har patienterna ett behov av goda copingstrategier och en god anpassning till livet med sjukdomen. Genom evidensbaserad och personcentrerad vård har sjuksköterskan en stödjande funktion i vården av dessa patienter. 

Syfte: Syftet med litteraturstudien var att undersöka patienternas upplevelser av att leva med inflammatorisk mag-tarmsjukdom för att kunna belysa deras behov av stöd.

Metod: En litteraturstudie med boolesk sökteknik gjordes i databaserna Cinahl, PubMed och PsycINFO där tio artiklar valdes ut genom granskning med SBU:s granskningsmall.   

Resultat: När resultatet av tio artiklar sammanställts framkom fyra teman; patienters upplevelser av att leva med inflammatorisk mag-tarmsjukdom, patienternas behov av stöd, stöd i att acceptera och leva med sjukdomen samt stöd i form av utbildning.

Slutsats: Patienter med inflammatorisk mag-tarmsjukdom har behov av stöd både fysiskt, psykiskt och socialt, från både sjukvårdspersonal och anhöriga. Patienterna har ett behov av stöd i form av information, undervisning samt psykiskt och emotionellt stöd. Sjuksköterskans stöd genom personcentrerad och empatisk kommunikation hjälper patienterna att acceptera sjukdomen och deras “nya normala”, vilket främjar deras självständighet, självkännedom och eget ansvar i sjukdomshanteringen. Patientutbildning bidrar till bättre egenvårdsstrategier, ökad följsamhet till behandling och livsstils anpassningar, vilket även bidrar till ökat självförtroende och välmående. 

Andersson, Oskar & Dahlin, Fanny. Arbetsrelaterad stress hos sjuksköterskor med fokus på upplevelser inom slutenvård. En litteraturstudie. Examensarbete i omvårdnad 15/30 högskolepoäng. Malmö Universitet: Fakulteten för hälsa och samhälle, institutionen för vårdvetenskap, 2021.Bakgrund: Arbetsrelaterad stress har under en längre tid varit vanligt förekommande inom vården och i synnerhet för sjuksköterskor. Under pandemin (Covid-19) har det blivit tydligt hur nära bristningsgränsen sjuksköterskor faktiskt var. Det är viktigt att förstå hur en stressig arbetsplats påverkar den omvårdnad som en sjuksköterska ska tillhandahålla, samt vilka andra konsekvenser en ohållbar och stressig arbetssituation kan leda till i längden.Syfte: Litteraturstudien syftade till att undersöka hur arbetsrelaterad negativ stress påverkar sjuksköterskans omvårdnadsarbete med fokus på sjuksköterskans upplevelser i slutenvården. Metod: Examensarbetet är en kvalitativ litteraturstudie. Litteratursökning gjordes i databasen PubMed. Samtliga artiklar är kvalitetsgranskade genom SBU:s granskningsmall för kvalitativa studier. Litteraturstudiens resultat är baserat på 10 artiklar. Resultat: I resultatet framkom 3 huvudteman; Arbetsmiljö, Organisatoriska faktorer och Coping. Utifrån dessa teman togs det sammanlagt fram 8 subteman; Arbetsbelastning, samverkan i team, relation mellan sjuksköterskor och läkare, återhämtning, organisatoriskt stöd, underbemanning, coping inom teamet och individuell coping. Konklusion: Organisatoriska faktorer är det som i störst utsträckning leder till arbetsrelaterad stress för sjuksköterskor. Underbemanning, tidsbrist och för många patienter per sjuksköterska är de största faktorerna. Arbete i team visar sig vara en större utmaning för sjuksköterskan än övriga yrkeskategorier inom slutenvården. Tillräckliga copingstrategier är essentiellt både på ett individuellt plan och på arbetsplatsen som helhet. Nyckelord: Kvalitativ forskning, psykologisk stress, slutenvård, sjuksköterskor, upplevelse

Andersson P, Peter M. Nurses experience of providing palliative care at home. A literature review. Degree Project 15 credit points in nursing. Malmö University, Faculty of Health and Society, Department of Care Science, 2021.

Background: Palliative care is provided when there is no cure for the patient's illness and more people are choosing to receive palliative care in their home. Palliative care focuses on supporting the patient whilst ensuring that their symptoms are relieved in a timely manner and is individually adapted to the patient and the relatives are encouraged to be involved in the palliative care. Furthermore, it is crucial that the patient know they are directly involved in the decisions that impact their end-of-life experience.

Aim: The purpose is to describe the nurse's experience of providing palliative care at home.

Method: The project was carried out as a literature study with a qualitative study design. The databases used in the literature searches were Cinahl and PubMed. The results of the literature study are based on 10 scientific articles that have been reviewed with the help of SBU:s review template for qualitative studies.

Results: 3 main categories emerged; challenges at work, information and support for relatives, the need for a god cooperation. These main categories were formed by the 9 subcategories; the need of knowledge, flexibility at work, emotional strain, to face ethical dilemmas, to create participation, create dialogue with relatives, postmortem, collaboration with nurse-colleagues, collaboration with physicians

Conclusion: Working in palliative care as a nurse can be stressful and affect the nurse negatively. It also requires a lot of commitment and knowledge from the nurse as they have a lot of responsibility. It is crucial that there is a clear and concise line of communication between all the parties involved in order to givethe patient the best end-of-life experience as possible.

AIMS AND OBJECTIVES: The aim of this study was to identify the most common serious adverse events that occurred in nursing homes and their most frequent contributing factors to contribute to improvement of safe nursing care. BACKGROUND: There is a need to improve safe nursing care in nursing homes. Residents are often frail and vulnerable with extensive needs for nursing care. A relatively minor adverse event in nursing care can cause serious injury that could have been preventable. DESIGN: This was a retrospective study, with a total sample of data regarding adverse events (n=173) in nursing homes, concerning nursing care reported by health care providers in Sweden to the Health and Social Care Inspectorate. The reports were analysed with content analysis and the frequencies of the adverse events, and their contributing factors, were described with descriptive statistics. RESULTS: Medication errors, falls, delayed or inappropriate intervention and missed nursing care caused the vast majority (89%) of the serious adverse events. A total of 693 possible contributing factors were identified. The most common contributing factors were 1) lack of competence 2) incomplete, or lack of documentation 3) teamwork failure 4) and inadequate communication. CONCLUSIONS: The contributing factors frequently interacted yet they varied between different groups of serious adverse events. The resident's safety depends on the availability of staff's competence as well as adequate documentation about the resident's condition. Lack of competence was underestimated by health care providers. RELEVANCE TO CLINICAL PRACTICE: Registered Nurses and assistant nurses need to have awareness of contributing factors to adverse events in nursing care. A holistic approach to improve patient safety in nursing homes requires competence of the staff, safe environments as well as resident's and relative's participation. This article is protected by copyright. All rights reserved.

Background: The health care system is facing a dilemma because of theincreasing demand of care and as well as the shortage of graduate level nurses andnurses with specialization. Earlier studies show that the shortage of nurses has ledto the necessity of delegating tasks to unlicensed health care personnel. Severalstudies showed that delegation is one of the areas within home care that has beenidentified a main risk in relation to health care injuries. Aim: To explore nurses’perspective of patient safety within home care in relation to delegation. Method:A literature review of eleven qualitative studies. The literature search wasperformed through database search (PubMed and Cinahl) and manual searching.The studies were reviewed through the SBU’s for qualitative studies and wereanalyzed with Friberg’s analysis method, where similar data were grouped intoappropriate categories. Result: The result yielded two main categories and sixsub-categories. The sub-categories, A helping hand, To lose control andDelegation barrier belongs to the main category The Delegation Dilemma. Underthe other main category, The delegation process there are three subcategories;Nursing diagnostics, Ensuring competence and to follow up delegated tasks.Conclusion: Delegation constitutes a great deal of responsibility and thedelegation process is complex. Delegation requires increased understanding andawareness of its complexity and what the responsibility of delegating entails, to beable to act effectively in order to maintain patient safety in relation to delegation. 

Bakgrund: Psykisk ohälsa är vanligt bland äldre och depression är den vanligaste psykiska sjukdomen. Depression är så pass vanligt förekommande bland äldre att det räknas som ett folkhälsoproblem. En känsla av nedstämdhet och ett minskat intresse och glädje vid aktivitet är några symtom på depression. Trots att det finns kännedom om att depression hos äldre är vanligt förekommande är det ett tillstånd som både är underdiagnostiserat och underbehandlat. Den grundutbildade sjuksköterskan möter dessa patienter inom primärvården och inom äldreomsorgen och har i uppgift att identifiera depressiva symtom och ge en god omvårdnad till äldre med depression. Syfte: Syftet med litteraturstudien är att beskriva vårdpersonalens upplevelse av att möta och vårda äldre personer med depression inom äldreomsorgen och primärvården. Metod: Litteraturstudien grundar sig på 10 vetenskapliga kvalitativa artiklar som har valts ut från databaserna Cinahl, Pubmed och PsycINFO. Analysen skedde med kvalitativ innehållsanalys på manifest nivå.

Resultat: Analysen mynnade ut i två kategorier; Den första var organisatoriska faktorer med subkategorierna organisationsstrukturens påverkan, riktlinjer och resurser samt samverkan. Den andra kategorin är mänskliga faktorer som beskrev upplevelser om stigma och felaktiga föreställningar, kontinuitet och holistiska synsätt är underkategorier. Konklusion: Sammanfattningsvis visar denna litteraturstudie att vårdpersonalen upplever vården vid psykisk ohälsa hos äldre som bristfällig. Frustration över resursbrist och ned prioriteringar av psykisk ohälsa samt att samverkan, kontinuitet och ett holistiskt synsätt var essentiellt. Dessa faktorer upplevdes påverka deras förutsättningar för att identifiera depression och möjliggöra en god vård.

Background: Migration has increased in recent years, therefore increasing the need for interpreters in healthcare. Communication between nurses and patients is crucial for a good relationship, something that is hindered when a language barrier is present. As of now there is no Swedish law that enforces the need of an interpreter in healthcare settings, however there is a law stating the right to equal care despite background. The patient's experience of interpreter use is one of the main foundations to achieve patient centered care. 

Aim: The aim of this study was to compile the patients’ experience using an interpreter in healthcare. 

Method: This study was a literature review with a qualitative approach. The databases that were used during this literature review were Cinalh and Psycinfo. Quality of the studies were assessed using SBU:s template for quality analysis. The result was analyzed with a qualitative content analysis specific for literature studies, to identify relevant categories and subcategories. 

Results: The results were based on 10 qualitative studies. The results are presented under three main categories: Limitations with communication and time, Patient’s expectations from the interpreter and Trust and confidentiality of the interpreter. The results showed that patients had a lack of trust in interpreters in regard to lack of confidentiality and the interpreter’s professionalism. The limitation with communication impacted the care for patients with a need for an interpreter, among other things owing to difficulties booking an interpreter and time pressure.

Conclusion: The interpreter's work of facilitating communication was crucial for person centered care and patient safety. There was a need for certified interpreters in order to ensure person centered care. The interpreter was crucial in order to enforce the patients participation in their healthcare, but many patients were uncomfortable with having the interpreter in the room. The nurse has a responsibility to meet the patients’ needs.  Relatives were used partly due to the lack of interpreters, more certified interpreters are needed in order to avoid this. The need for further knowledge for nurses in regards to interpreter use within healthcare was identified through this study.

BACKGROUND: Limited scientific evidence for prevention and treatment of diabetic foot ulcers in elderly with comorbidities.

AIM: To explore patient-related factors and outcomes in patients ≥75 years with diabetes and a foot ulcer.

METHOD: Sub-analysis of consecutively presenting patients ≥75 years (N = 1008) from a previous study on 2,480 patients with diabetic foot ulcer treated in a multidisciplinary system until healing. Patient characteristics: age - 81(75-96); diabetes type 2-98.7%; male/female - 49/51%; living with a spouse - 47%; nursing home 16%; or with home nursing 64%.

RESULT: Primary healing was achieved in 54%, minor amputation 8%, major amputation 9%, auto-amputation 2%, and 26% of the patients died unhealed. Among the oldest (88-96 years), 31% healed without any amputation. Extensive comorbidities were frequent: neuropathy 93%, visual impairment 73%, cardiovascular disease 60%, cerebrovascular disease 34%, and severe peripheral disease in 29% of the patients. Out of patients (80%) living in institutions or dependent on home nursing, 56% healed without amputation, compared to 44% of patients living in their own home without any support from social services or home nursing.

CONCLUSION: Healing without major amputation was achieved in 84% of surviving patients ≥75 years, despite extensive comorbidity and dependency.

OBJECTIVE: To compare the number of ulcer-free days during 24 months in persons with diabetes and a healed foot ulcer below the ankle provided with adjusted therapeutic shoes who were given standard information and participated in participant-driven group education compared with standard information alone.

METHOD: A randomized controlled trial was designed to evaluate the number of ulcer-free days after participant-driven group education in addition to standard information compared to standard information alone. The number needed to treat (N=174) was not met, as only n=138 persons with diabetes and previously healed foot ulcer were recruited (age median 63 years [34-79], 101 male/37 female).

RESULT: 138 persons were recruited, of whom 107 (77.5%) completed the study, 7 (5%) dropped out, and 12 (9%) became deceased. No statistically significant difference was found between the intervention group compared to the control group after 6, 18, or 24 months. After 12 months, more patients in the intervention group had developed ulcers. Seventy-seven participants (56%) developed new foot ulcers, irrespective of side and site. Development of one ulcer appeared in 36 participants, two ulcers in 19, and 22 participants developed three ulcers. Forty-eight participants remained ulcer-free (35%) during the 24-month follow-up. Median ulcer-free days until first ulceration were 368 (4-720); until second ulceration, 404 (206-631); and until third ulceration, 660 (505-701). The participants wore prescribed therapeutic shoes during 88% of the follow-up visits.

CONCLUSION: One third of the participants remained ulcer free for 24 months. Patient-driven education in groups did not give better results than standard information in this underpowered study. The present study illustrates the challenges to perform comparative preventive studies in this group of patients with extensive comorbidity. Further studies are needed to evaluate interventions on ulceration in persons with a healed foot ulcer.

Bakgrund: Den svenska sjukvården har stått inför utmaningen att behålla sjuksköterskor i över ett decennium. Magnetmodellen är ett tillvägagångssätt som visat sig vara framgångsrikt på andra håll i världen för att vända negativa trender i bristen på sjuksköterskor. Structural empowerment är en av de fem kärnkomponenterna i Magnetmodellen. Det krävs en förändring av organisations- och ledningsstrukturer så att sjuksköterskor äger frågor inom sin profession och stärks i sin professionella utveckling. Professional governance kan betraktas som ett ramverk för structural empowerment. Med denna bakgrund finns också ett behov av att utvärdera och mäta professional governance. Det finns dock inga validerade instrument för att mäta professionell styrning i svensk kontext.

Syfte: Syftet med studien var att översätta, anpassa och validera the Verran Professional Governance Scale till svenska.

Metod: Översättning, anpassning och validering av instrumentet i fem faser: översättning av instrumentet från originalspråket engelska till svenska, syntetisering av två versioner till en, back translation, expertpanel, pilottestning av den svenska versionen av instrumentet och kognitiva intervjuer med fem sjuksköterskor. Data analyserades med innehållsanalys med RITA metoden.

Resultat: Översättningsprocessen i fem faser resulterade i en ny svensk version av instrumentet. Språklig validitet och användbarhet bekräftades i steg fyra och fem. Konsensus uppnåddes i expertgruppen och S-CVI värdet, .95, visar hög relevans. I analysen av de kognitiva intervjuerna framkom att inledningen och vissa ord och meningar i några påståenden behövde revideras till exempel vår arbetsplats.

Slutsats: Studien har genererat översättning och validering för The Verran Professional Governance Scale och utgör en lovande start inför fortsatta valideringsstudier. Den svenska versionen kan lyfta sjuksköterskans profession och sätta fokus på omvårdnad, som en del av Magnetmodellen.                                                                                         

Nyckelord: Magnetmodellen, professional governance, structural empowerment, The Verran Professional Governance Scale

Registered nurses [RNs] are within the frontline of professional nursing and are expected to provide a diverse range of health care services to a varied and heterogenic group of patients. They are bound by a code of ethics that mandates that nurses respect all human rights regardless of the patient’s abilities or functional status. However, research implies that RNs do not feel adequately prepared to support patients with intellectual and developmental disabilities [IDD], and that patients with IDD are often misinterpreted and misunderstood in care. Gaining in-depth knowledge about how RNs can experience nursing for this group of patients is therefore of great importance. The overall aim of this thesis was to describe, appraise, integrate and synthesise knowledge concerning nursing for patients with IDD. A further aim was to explore and describe Swedish RNs’ perceptions of providing care for patients with IDD within a home health care setting.

This thesis consisted of two studies designed to investigate various aspects of nursing and caring for patients with IDD. Paper I was a systematic review using a meta-ethnographic approach, and Paper II was an interview study using a qualitative descriptive, interpretive design. Data was collected by systematic data base searches (Paper I), and by individual interviews (Paper II). The systematic review comprised 202 RNs (Paper I) and the qualitative descriptive study comprised 20 RNs. 

In the systematic review, data was analysed by a Line of Argument Synthesis [LOAs] as described by Noblit and Hare (1988), while the data in Paper II was analysed by content analysis.  

Nurses’ experiences and perceptions of nursing patients with an IDD could be understood from 14 LOAs. Six of these were interpreted to reflect a tentatively more distinctive and unique conceptualisation of RNs’ experience of nursing for this group of patients. The remaining eight LOAs were interpreted to reflect a conceptualisation of nursing per se that is a universal experience regardless of context or patient group (Paper I). In Paper II, the nurse’s perceptions were interpreted to be reflected by three overarching categories: Nursing held hostage in the context of care, Care dependant on intuition and proven experience and Contending for the patient’s right to adequate care.  

Absence of understanding and knowledge about IDD might be an explanation for the “otherness” that still appears to surround this group of patients. Concentrating on the person behind the disabilities label as well as on abilities instead of disabilities could be a reasonable approach in nursing care for patients with IDD. Thus, implementing nursing models focusing on person-centred care could support RNs to moderate the health and care inequalities that are still present among patients with IDD (Paper I). 

As a result of the home health care context and its organisation, the RNs perceived themselves as unable to provide care in accordance with their professional values. Not mastering the available augmentative and alternative communication tool additionally meant having to provide care based on second-hand information from support staff. The RNs also perceived that caring for this group of patients involved a daily battle for the patient’s rights to receive the right care at the right place and time and by the right person (Paper II). Hence, a broad base of evidence on what actually works best in clinical practice for this group of patients, particularly in the home care context, is still needed.

Background: Research suggests that registered nurses (RNs) do not feel adequately prepared to support patients with intellectual disability disorder (IDD). This is unsurprising, as few European health sciences curricula include undergraduate and graduate training courses in IDD. As RNs are often in the front line of care, eliciting in-depth knowledge about how they experience nursing this group of patients is vital. Our aim in this study was to develop a conceptual understanding about RNs’ experiences of nursing patients with IDD. Method: We undertook a systematic review and meta-ethnography to synthesise qualitative research studies found in PubMed, CINAHL, PsycINFO, ERIC databases and by manual searching to identify additional studies. We condensed translatable second-order constructs, and developed an idiomatic translation. Finally, we formulated line of argument (LOA) syntheses to capture the core of the idiomatic translations. Results: We included eighteen published studies from eight countries involving 190 RNs. The RNs’ experience of nursing patients with IDD were reflected in 14 LOAs. Six of these reflected a tentatively more distinctive and at times unique conceptualisation of RNs’ experience of nursing this group of patients. The remaining eight LOAs represented a conceptualisation of nursing per se, a conceptualisation of nursing that was interpreted as a universal experience regardless of context and patient group. Conclusion: Lack of awareness and knowledge are likely breeding grounds for the ‘otherness’ that still surrounds this group of patients. In encounters between patients and RNs, focusing on the person behind the disability label could be one way to secure relevant nursing care for patients with IDD. Undertaking appropriate under- and postgraduate education alongside the implementation of nursing models focusing on patient-centred care would help RNs in reducing the health and care inequalities this group of patients still face.

Patients with intellectual and developmental disability (IDD) are often misinterpreted and misunderstood. Studies show that, in general, healthcare professionals have limited knowledge about IDD, and registered nurses (RNs) often report feeling unprepared to support this group of patients. Therefore, more knowledge about how to adequately address care for this patient group is warranted. This qualitative study employs an interpretative descriptive design to explore and describe Swedish RNs' perceptions of caring for patients with IDD, here in a home-care setting. Twenty RNs were interviewed between September 2018 and May 2019, and the resulting data were analysed through an inductive qualitative content analysis. The study adheres to consolidated criteria for reporting qualitative research (COREQ). Our analysis found that nurses' perceptions of caring for patients with an IDD could be understood from three overarching categories: nursing held hostage in the context of care, care dependent on intuition and proven experience and contending for the patients' right to adequate care. Our findings show that the home-care context and organisation were not adjusted to the needs of the patients. This resulted in RNs feeling unable to provide care in accordance with their professional values. They also explained that they had not mastered the available augmentative and alternative communication tools, instead using support staff as interpreters for their patients. Finally, on a daily basis, the RNs caring for this group of patients took an active stance and fought for the patients' right to receive the right care at the right time by the right person. This was particularly the case with issues involving psychiatric care.

Background: In August of 2017, the Nursing Leadership Collaborative of the International Network of Universities (INU), convened in Hiroshima, Japan to hold a patient safety and quality of care workshop for nursing students from six INU universities located in Japan, Spain, Sweden, South Africa, United Kingdom and the United States. The workshop, held during Peace Week, had as its purpose to develop a model of international collaboration and education to impact quality and safety education in nursing. In addition to examining the impact of the experience on student learning, the leaders wished to determine to what degree students’ beliefs and values changed due to participation in the nursing collaborative workshop. The purpose of this research was to measure students’ self-reported beliefs that reflect global competency and openness to cultural diversity. Methods: IRB approval was obtained and a pre-post-test mixed method design was used with the convenience sample of 21 English speaking international undergraduate and graduate nursing students. The workshop lasted 9 days and included a curriculum based on the Quality and Safety Education for Nurses (QSEN) Competencies. Experiential clinical activities focused on how patient safety is improved in Japan. Cultural activities were integrated and primarily focused on the Peace Week events which included the Peace Day ceremony to memorialize the dropping of the atomic bomb on Hiroshima. The Beliefs, Events, and Values Inventory (BEVI), a mixed methods measure, was administered and used to asses relevant processes and constructs including (but not limited to); openness; receptivity to different cultures; stereotyping; self and emotional awareness; and strategies for making sense of why people do what they do. (Shealy, 2017). This study examines Time 1 (prior to participation in the program) and Time 2 (immediately after the completion of the program). Students also completed daily reflections in response to prompts provided by faculty. Qualitative data analysis was completed using NVivo software. Results: Results from the group aggregate data analysis indicate that prior to the start of the program (Time 1) this group presents itself as quite introspective (Self-awareness = 75thpercentile); midway between confident and inquisitive in terms of understanding who others are, how world works, and their experience of life (Basic Determinism = 41st percentile); quite open to and interested in cultural beliefs and practices that are different from one’s own (Sociocultural Openness = 74th percentile); open to non-traditional gender roles (Gender Traditionalism = 20th percentile); do not have strong religious convictions (Religious Traditionalism = 26th percentile); and express a high degree of concern about ecological issues and the natural world (Ecological Resonance = 59th percentile). Following the completion of the program (Time 2), the group as a whole reported being more sophisticated in making causal explanations about why the world works in the way it does (Basic Determinism = 30th percentile); increased openness to and interest in cultural beliefs and practices that are different from one’s own (Sociocultural Openness = 80th percentile); increased openness to non-traditional gender roles (Gender Traditionalism = 13th percentile); further decrease in strong religious convictions (Religious Traditionalism = 20th percentile); and increased degree of concern about ecological issues and the natural world (Ecological Resonance = 71stpercentile). Statements from qualitative data analysis reflect greater understanding and empathy for others’ perspectives and experiences and increased openness. Conclusion: Nursing students experienced changes in their beliefs and values that reflect a greater degree of global competency after the short term international workshop experience with other nursing students.

OBJECTIVES: An international Nursing Leadership Collaborative covened in Japan to hold a patient safety and quality workshop for nursing students from six countries. The purpose was to measure students' self reported beliefs reflecting sensitivity and openness to cultural diversity before and after the international experience.

METHODS: A pre-post-test design was used and the Beliefs, Events, and Values Inventory was administered to international undergraduate and graduate nursing students.

RESULTS: The group aggregate data analysis indicate that prior to the start of the workshop, the group presented itself as quite introspective and after the workshop the group reported being more sophisticated in making causal explanations about why the world works in the way it does.

CONCLUSIONS: Nursing students experienced an expanded awareness of their beliefs and values that reflect a greater degree of intercultural sensitivity for acceptance of inclusivity and diversity after the experience.

Background: I relation with the increased migration over the past decade, the Swedish health care has encountered an increasingly heterogeneous working class. The increasingly heterogeneous work environment has meant that nurses encounter new challenges that affect nursing work, where the language barrier between patient and nurse has a negative impact on the care provided. When communication between these two parties is lacking, patient safety is jeopardized. Thus, communication is crucial and fundamental to achieve good quality of care where patients’ individual needs can be met. Aim: The aim of the literature study was to compile nurses' experiences of language barriers in communication within health care. Method: The essay is based on a compilation of twelve literature studies with a qualitative approach. A systematic literature study based on scientific publications that deal with scientific studies. The database search was performed in CINAHL and PubMed and focuses on nursing. The studies were reviewed according to the inclusion and exclusion criteria. The quality of the studies was then reviewed based on SBU's quality review template and the content was analyzed using content analysis to identify relevant themes. Results: The results of the literature study are presented based on three themes, which includes: language barriers as a challenge, communication with interpreters and barriers to cultural understanding. The identified themes include five subthemes. Conclusion: Language barriers affect nurse's nursing work. When language barriers exist, the exchange of information between nurse and patient is limited. Working from a holistic approach cannot be maintained and nursing is affected.

Background: Patients with opioid- or drug addiction is a vulnerable group in healthcare. The patients often experience distrust and that they don’t get the help they need. It is known that nurses experience a lack of knowledge, has a negative attitude towards these patients and allows past experiences to affect the nursing care. Nurses needs to possess an awareness regarding their attitudes and experiences to avoid this effecting the person-centered care. Aim: To investigate how nurses’ experiences and attitudes towards people with an opioid- or drug addiction affect the nursing of this patient group within somatic care. Method: Qualitative literature review where Cinahl, Psycinfo and Pubmed were used as databases for the search of literature. Review of the articles was based on SBU’s quality review template. Analysis of the articles were done accordingly to Popenoe. Result: The results describe different aspects that affect the nursing care of opioid- or drug addictive patients. The result is divided into two categories: Wrong focus in nursing, The nurses want to provide person-centered care and five sub-categories: The nurses emotions affect the nursing care, Patients are distrusted, Uncertainty and lack of knowledge, Patients deserve good care, Experience contribute to good care. Conclusion: Nurses experience patients with opioid- or drug addiction as demanding and complex. The patients evoke feelings such as irritation, suspicion and anger but also sympathy and compassion. This is due to the nurse’s lack of knowledge and experience. Despite this, the nurses feel a responsibility towards the patients and want to provide good care.

Despite the high rates of HIV infections in Tanzania, significant gaps in the depth and comprehensiveness of HIV knowledge persist among the population in Tanzania. The aim of our study was to explore nurses’ experiences of providing information about HIV prevention in Tanzania. Semi-structured interviews with open-ended questions were conducted with eight nurses in health care centers. The interviews were transcribed and analyzed using qualitative content analysis as described by Burnard. The results showed that the nurses carried out the preventive HIV work by giving information, offering counselling, and teaching precautions. The nurses faced many challenges: for example, misconceptions about condom use, people’s lack of information about HIV, dealing with the stigma attached to HIV, and the lack of resources in the country. The preventive work affected the nurses emotionally, as they felt a sense of social responsibility to help prevent HIV. Key words: experiences, HIV prevention, information, nursing, qualitative study, Tanzania.