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  • 1801.
    Säfström, Anna
    Umeå University, Faculty of Medicine, Department of Nursing.
    Humor - en naturlig del i omvårdnaden av ett sjukt barn.2013Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Humor kan vara ett sätt att kommunicera men kan även fungera som en copingmekanism för att hantera och bemästra svåra situationer. I mötet mellan människor kan humor skapa goda relationer och vara en isbrytare. Inom barnsjukvården kan humor gebarnet en möjlighet till avslappning och distans till obehag. Syftet med studien var att beskriva barnsjuksköterskors syn på humor och tillämpandet av humor vid omvårdnaden av ett sjukt barn. Studien genomfördes som en empirisk studie med kvalitativa intervjuer med nio barnsjuksköterskor. Intervjuerna analyserades med kvalitativ innehållsanalys. Resultatet redovisas i fem teman: humor ger en tillåtande atmosfär, humor en naturlig del i omvårdnaden, humor kan vara sårande, humor kan vara ett arbetssätt och humor skapar en personlig kontakt till barn och familj. Humor avdramatiserade och gav en avslappnad och personlig stämning. Det var ett sätt för sjuksköterskan att inge trygghet och förtroende. Sjuksköterskorna var positiva till användandet av humor i omvårdnaden men måste vara lyhörda för när det är passande och inte. Humor användes ävenmellan personalen som ett sätt att hantera situationer som uppstod iarbetet och både barn och familj upplevdes mottaga humor positivt. Humor kan ses som ett verktyg som sjuksköterskan med fördel kan använda i arbetet. Ytterligare forskning är önskvärt för att utforska ämnet ytterligare.

  • 1802.
    Sävenstedt, Stefan
    Umeå University, Faculty of Medicine, Department of Nursing.
    Telecare of frail elderly: reflections and experiences among health personnel and family members2004Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Telecare has been an approach to care that, internationally, has experienced a generally rapid development during the last ten years. There are many examples of successful pilot projects where ICT applications have been used in the care of elderly: for improved remote consultation with health professionals, to improve the communication and support of the elderly person’s social network, and as intelligent sensors intended to improve the safety of the elderly person. Despite these successes, implementation has been slow. This research project was set up to provide additional knowledge on some of the important questions regarding quality and implementation aspects of the use of ICT application on the care of frail elderly persons. The overall aim of the research project is to illuminate reasoning and experiences of using applications of telecare for frail elderly persons.

    The research project comprised five studies that were conducted using qualitative research methods. Four of them were carried out within the framework of three telecare projects. Different qualitative research approaches such as content analysis, phenomenological hermeneutics and conversational and discourse analysis were used, in accordance with the research questions of each study. The experiences revealed in the findings of the studies indicate that it is possible to have communication of good quality via videoconferencing with frail elderly persons, even those that have mild or mid-level dementia, provided the conditions are right. Technical limitations of the videoconferencing media in transferring communication cues and the limitations on what the camera can expose place special demands on those communicating with the frail elderly and on the general setting. On the other hand, these limitations on the context of interaction in some situations also seem to be an advantage for demented elderly persons and contribute to increased attention. One example of meaningful remote communication with frail elderly persons was family members’ videophone conversations with their demented relatives when they were placed in nursing homes or homes for respite services. This communication gave new possibilities of being involved in caring for, and of maintaining a relationship with, their demented relative. An introduction of teleconsultations in the care of frail elderly persons will, according to the experiences recorded, affect the professional role and the practical spheres of involved health professionals. The perceptions and experiences of participating health personnel indicate that in order for ICT applications to become valuable assets in the care of frail elderly persons they have to be part of a care alternative that is viewed by all concerned as the best alternative, as a whole, for all affected parties. Further research is needed in order to confirm or refute the findings of this thesis and in order to further broaden our understanding of the use of ICT applications in the care of frail elderly persons. This could facilitate a development of ICT applications suitable for the care of frail elderly persons and their introduction into regular care activities, to the benefit of both the frail elderly persons and their carers.

  • 1803.
    Sävenstedt, Stefan
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing.
    Family members’ narrated experiences of communicating via video-phone with patients with dementia staying at a nursing home2003In: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, Vol. 9, no 4, p. 216-220Article in journal (Refereed)
    Abstract [en]

    We studied the experience of family members who communicated via video-phones with elderly demented patients who were either staying at a home for temporary respite care or living in a nursing home. The study was based on qualitative data from seven interviews. The interviewees each had three or more months' experience with a video-phone. The open interviews were transcribed. Content analysis showed that video-phone conversations made the relatives of patients at nursing homes more involved in the caring process and that conversation via the video-phone was a different way of communicating. Video-phone conversations with demented patients were in some cases more focused and of better quality than face-to-face conversations. In most cases the video-phone conversations required the assistance of staff at the home in order to be meaningful. Video-phones have the potential to become useful tools for family members caring for elderly relatives.

  • 1804.
    Sävenstedt, Stefan
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Bucht, Gösta
    Norberg, Lennart
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nurse-doctor interaction in teleconsultations between a hospital and a geriatric nursing home2002In: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, Vol. 8, no 1, p. 11-18Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to elucidate both the interactionbetween a doctor and five registered nurses and the problemsor tasks dealt with in teleconsultations between a universityclinic for geriatric medicine and a nursing home for the elderlyin northern Sweden. The interaction and problems or tasks werestudied through analyses of video-recorded teleconsultationsand through open interviews with the participating staff. Theresults indicated that teleconsultations between a geriatricianand the nurses at a nursing home for the elderly can be a usefultool for providing medical services. Teleconsultations alterboth the 'power-control' and 'practice spheres' for the doctorand the nurses, and must be based on mutual trust. The use ofteleconsultations gives the nurse a larger role as the presenterof medical problems, and gives the doctor the role of remoteconsultant.

  • 1805.
    Sävenstedt, Stefan
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Häggstrom, Terttu
    Working with girls living on the streets in East Africa: professionals' experiences.2005In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 50, no 5, p. 489-97Article in journal (Refereed)
    Abstract [en]

    AIM: This paper reports a study elucidating the meaning of caring for girls of the street, as experienced by female staff members working with street children in Eastern Africa. BACKGROUND: The phenomenon of children living on the streets is a global and escalating problem, and girls are presumed to be especially vulnerable. In East Africa, the traditional extended family system is rapidly breaking down and traditional gender values seem to remain. This was the context for investigating female carers' experience of caring for girls. METHOD: Interviews were conducted with 37 project staff members working with children living on the streets in the framework of non-governmental organizations in Kenya, Uganda and Tanzania between 1997 and 1998. Transcribed text from female interviewees (n = 13) working with girls of the street was analysed using a phenomenological-hermeneutic approach. FINDINGS: The meaning of caring for girls of the street for female professional carers in East Africa was comprehensively understood as counselling the girls to integrate the past of their adverse life stories with their present identity. Counselling meant conveying visions for a possible re-direction of the life stories, from being a girl of the street into being an accepted family girl. Caring in this context meant being squeezed between ethical demands and gender values. Experiencing frustration and powerlessness was related to gender structures in society, having to fight the grip of street culture, and a lack of professional tools. Hope and satisfaction were related to success in changing the course of life stories of girls and to seeing possibilities for contributing to empowerment of girls and community members. CONCLUSIONS: Gender issues are critical to care provided to girls of the street. Carers felt that they lacked relevant knowledge and support. Ethical aspects and gender issues in relation to professional care for vulnerable girls ought to be addressed in nursing education and practice, not only for developing countries, but also as a matter of global interest.

  • 1806.
    Sävenstedt, Stefan
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandman, Per Olof
    Umeå University, Faculty of Medicine, Department of Nursing.
    Zingmark, Karin
    Research Manager, Department of Research and Development, Norrbotten County Council, Luleå , Sweden.
    The duality of information and communication technology (ICT): Inexperienced health personnel’s reasoning regarding the use of ICT in the care of frail elderlyManuscript (Other academic)
  • 1807.
    Sävenstedt, Stefan
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing.
    Zingmark, Karin
    Research Manager, Department of Research and Development, Norrbotten County Council, Luleå , Sweden.
    The duality in using information and communication technology in elder care.2006In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 56, no 1, p. 17-25Article in journal (Refereed)
  • 1808.
    Sävenstedt, Stefan
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Zingmark, Karin
    Hydén, Lars-Christer
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Establishing joint attention in remote talks with the elderly about health: a study of nurses' conversation with elderly persons in teleconsultations2005In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 19, no 4, p. 317-24Article in journal (Refereed)
    Abstract [en]

    This study is a contribution to the sparsely studied field of nurses' teleconsultations with frail elderly people. The aim was to describe how talk and interaction are accomplished and by what means problems are handled that emerge from the fact that the communication is conducted via videoconferencing techniques. Recordings were made of 22 sessions of teleconsultation between nurses and elderly nursing home residents aided by enrolled nurses. The data were analysed with a qualitative method inspired by conversation and discourse analysis. The findings indicate that in order to create a joint attention the participants often had to verbally confirm and reconfirm that contact had been established. The triad of participants played a special part in maintaining the joint attention through compensating for the contextual aspect of the medium's limitations and the demented elderly person's communication problems. 'Talks about the communication' and passages of social talk took place when the nurse or the staff member wanted to re-establish and maintain joint attention. The joint attention seemed connected to a special sort of eye contact and gaze and to the type of camera projection that was used. One conclusion was that to create joint attention in nurses' teleconsultations with frail elderly people, the limitations in transferring communication cues and the limitations of what the camera can reveal of the general context could, to some extent, be made up for by verbal communication within the triad of participants. Another conclusion was that these limitations in the context of interaction in some situations also seemed to be an advantage for the demented elderly and contributed to increased attention

  • 1809.
    Sävenstedt, Stefan
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Zingmark, Karin
    Department of Research and Development, County Council of Norrbotten, Luleå, Sweden..
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing.
    Being present in a distant room: A study of the qualitative aspects of teleconsultations with older people in a nursing home2004In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 14, no 8, p. 1046-1057Article in journal (Refereed)
  • 1810.
    Söderberg, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Gilje, F
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Dignity in situations of ethical difficulty in intensive care.1997In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 13, no 3, p. 135-44Article in journal (Refereed)
    Abstract [en]

    In intensive care, situations of ethical difficulty are common. For the purpose of illuminating the meaning of being in ethically difficult situations, 20 registered nurses (RNs) employed in six intensive care units in Sweden narrated episodes of ethical difficulty. From a phenomenological hermeneutic perspective, the core theme of 'dignity' was identified in 85 stories. Stories with the concept of dignity reveal a threefold meaning; transforming disrespect into respect for the inviolable value of the human being; transforming ugly situations into beautiful ones; transforming discord of death into togetherness. Stories without the concept of dignity were oriented toward skills and physical care without reflection on actions and a 'taken-for-granted attitude' that good will prevail. Comparing and contrasting stories with and without dignity revealed the demands of dignity: attentiveness, awareness, personal responsibility, engagement, fraternity and active defence of dignity. In light of the philosophies of Weil, Marcel and Ricoeur, the demands of dignity correspond to qualities generated when struggling for respecting the dignity of human beings. This study reveals that dignity begets dignity, which opens the RNs to the ethical dimension. This, in turn, counteracts the risk of dehumanizing care in technocratic environments.

  • 1811.
    Söderberg, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Gilje, Fredricka
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Transforming desolation into consolation: the meaning of being in situations of ethical difficulty in intensive care.1999In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 6, no 5, p. 357-73Article in journal (Refereed)
    Abstract [en]

    The purpose of this phenomenological-hermeneutic study was to illuminate the meaning of being in ethically difficult care situations. The participants were 20 enrolled nurses employed in six intensive care units in Sweden. The results reveal a complex human process manifested in relation to one's inner self and the other person, which transforms desolation into consolation through becoming present to the suffering other when perceiving fragility rather than tragedy. The main point of significance here is for all health professionals to create an ethical work environment and strive for praxis that fosters 'at-homeness', which renders us free to transform desolation into consolation. Consolation is of significance in ethics because it makes us available and helps us to fulfil the demands of life, while desolation makes us unavailable to others.

  • 1812.
    Söderberg, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Intensive care: situations of ethical difficulty.1993In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 18, no 12, p. 2008-14Article in journal (Refereed)
    Abstract [en]

    Twenty enrolled nurses (ENs), 20 registered nurses (RNs) and 20 physicians working in intensive care in northern Sweden narrated 255 stories about their experience of being in ethically difficult care situations. The ENs' stories mainly concerned problems relating to relationship ethics, the stories narrated by the physicians mainly concerned problems relating to action ethics, while the RNs' stories gave equal attention to both kinds of problems. The most common theme of both the RNs' and the physicians' stories was that of too much treatment. An obvious similarity between the ENs, RNs and physicians was that they saw themselves as equally lacking in influence in ethically difficult care situations. The only apparent difference between the three groups, however, was that the ENs brought up relationship problems more often than the others. Thus, the differences between the RNs and the physicians were fewer than usually reported in the literature. This might be related to the specialization of intensive care.

  • 1813.
    Söderberg, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Gilje, Fredricka
    Meeting tragedy: interviews about situations of ethical difficulty in intensive care.1996In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 12, no 4, p. 207-17Article in journal (Refereed)
    Abstract [en]

    For the purpose of illuminating the meaning of being in ethically difficult situations, eight enrolled nurses, 12 registered nurses and 10 physicians (n = 30) working in intensive care units in Sweden were asked to narrate care episodes of ethical difficulty. A phenomenological-hermeneutical analysis of the 30 narratives about nine care episodes disclosed that all stories concerned meeting tragedy, which evoked a spirit of compassion that pointed to values. The 'intention of compassion' aimed at respecting these ethical values. Respecting ethical values meant being consoled, which generated confidence in life that helped the person to embrace tragedy. When values were not respected, ethical problems emerged. Communication of values facilitated realisation, while unconscious values were indirectly communicated through emotions. Such communication meant risking vulnerability and meeting oneself. Meeting self and one's vulnerability demanded abilities of being consoled, i.e. in this study giving consolation, providing realistic treatment and being faithful in one's profession. A prerequisite for expressing personal standpoints and cooperating in the struggles of respecting ethical values was holding each other in great respect. When meeting tragedy, the spirit of compassion pointed to ethical problems, to the possibilities of solving the problems, and to the fulfilment of vision through converting feelings of despair into action energy.

  • 1814.
    Söderberg, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Grankvist, Kjell
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Wallin, Olof
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Preanalytical errors in primary healthcare: a questionnaire study of information search procedures, test request management and test tube labelling2009In: Clinical Chemistry and Laboratory Medicine, ISSN 1434-6621, E-ISSN 1437-4331, Vol. 47, no 2, p. 195-201Article in journal (Refereed)
    Abstract [en]

    Background: Most errors in laboratory medicine occur in the preanalytical phase and are the result of human mistakes. This study investigated information search procedures, test request management and test tube labelling in primary healthcare compared to the same procedures amongst clinical laboratory staff.

    Methods: A questionnaire was completed by 317 venous blood sampling staff in 70 primary healthcare centres and in two clinical laboratories (response rate = 94%).

    Results: Correct procedures were not always followed. Only 60% of the primary healthcare staff reported that they always sought information in the updated, online laboratory manual. Only 12% reported that they always labelled the test tubes prior to drawing blood samples. No major differences between primary healthcare centres and clinical laboratories were found, except for test tube labelling, whereby the laboratory staff reported better practices. Re-education and access to documented routines were not clearly associated with better practices.

    Conclusions: The preanalytical procedure in the surveyed primary healthcare centres was associated with a risk of errors which could affect patient safety. To improve patient safety in laboratory testing, all healthcare providers should survey their preanalytical procedures and improve the total testing process with a systems perspective.

  • 1815.
    Söderberg, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Grankvist, Kjell
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Wallin, Olof
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Incident reporting practices in the preanalytical phase: low reported frequencies in the primary health care setting2009In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 69, no 7, p. 731-735Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Incident reporting is commonly used to improve patient safety. The preanalytical phase of laboratory testing contains several manual error-prone tasks where mistakes can affect patient outcomes. However, the practical use of incident reports in this area has not been previously investigated in the primary health care setting, where the majority of the patients come in contact with health care.

    MATERIAL AND METHODS: All staff responsible for venous blood sampling in 70 primary health care centres and in two hospital clinical laboratories (317 respondents, response rate 94%) completed a questionnaire.

    RESULTS: Of the primary health care staff, 69% reported that they had never filed an incident report regarding venous blood sampling. Barriers for not filing incident reports often/always included lack of time (44%) and a complicated reporting procedure (27%). A higher proportion of staff with re-education (43%) had filed at least one incident report as compared to those without re-education (20%, p < 0.001). No differences in incident reporting practices were found between primary health care and hospital clinical laboratory staff.

    CONCLUSIONS: The investigated incident reporting system is likely to underreport incidents in the preanalytical phase. Therefore, the ability to discover preventable system vulnerabilities needs refinement.

  • 1816.
    Söderberg, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences.
    Wallin, Olof
    Umeå University, Faculty of Medicine, Department of Medical Biosciences.
    Grankvist, Kjell
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Is the test result correct? A questionnaire study of blood collection practices in primary health care2010In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 16, no 4, p. 707-711Article in journal (Refereed)
    Abstract [en]

    Rationale, aims and objectives  Venous blood tests are important for clinical decision making. Most errors in blood testing are due to human errors before the blood samples reach the laboratory. The present study was designed to investigate venous blood sampling (VBS) practices in primary health care centres (PHCs) compared with clinical laboratory staff.

    Method  A cross-sectional survey of 70 PHCs and two clinical laboratories is conducted. All staff responsible for VBS (317 respondents, response rate 94%) completed a questionnaire on VBS practices.

    Results  Instructions for VBS were not followed in the surveyed PHCs. For example, only 54% reported that they always identified the patient by using name/Swedish identification number and only 5% reported that they always used photo-ID, the two preferred means for patient identification. Only 12% reported that they always released venous stasis as soon as possible. Fewer PHC staff than clinical laboratory staff reported correct VBS practices. For example, 54% of the PHC staff reported that they always identified the patient by name and Swedish identification number, as compared with 95% of the clinical laboratory staff (P < 0.001). Documented VBS routines and re-education in VBS were not clearly associated with reported correct VBS practices.

    Conclusions  In the surveyed PHCs, there are clinically important risks for misidentification of patients and erroneous test results, with consequences for the diagnosis and treatment of patients. Quality interventions, aimed at improving VBS practices, are needed to ensure patient safety.

  • 1817.
    Söderberg, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Wallin, Olof
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Jonsson, P. Andreas
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Grankvist, Kjell
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Comment on the letter to the editor ‘The importance of incident reporting in laboratory diagnosics’ by Lippi and Plebani2009Other (Other academic)
  • 1818.
    Söderberg, Marcus
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brännström, Emil
    Umeå University, Faculty of Medicine, Department of Nursing.
    Kvinnors upplevelser av anorexia nervosa: En litteraturstudie2016Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Trots att alla äter har samhället svårt att förstå tanken av oreglerat ätande. Ätstörningar är ett stort och växande problem runt om i världen, och med förändrade sociokulturella normer och ideal ställs orealistiska krav på många människor, i synnerhet unga kvinnor. Dessa förväntningar tvingar kvinnor att ta till extrema metoder för att gå ner i vikt, följt av en vardag som präglas av dåligt självförtroende och andra psykiska konsekvenser. Syfte: Syftet med studien var att beskriva kvinnors upplevelser av anorexia nervosa. Metod: Tio kvalitativa studier har kvalitetsgranskats, analyserats och sammanställts till litteraturstudiens resultat. Resultat: Resultatet presenteras i tre kategorier och elva underkategorier. Resultatet visar att de bakomliggande orsakerna upplevs vara en kombination mellan låg självkänsla, lågt självförtroende och yttre förväntningar och påtryckningar. Anorexia nervosa upplevs som ett funktionellt verktyg, men övergår med tiden till en kontrollerande sjukdom som måste förgöras. Konklusion: Att leva med anorexia nervosa präglas av ambivalens och förvirring. Det är svårt att släppa taget om något som har blivit ens identitet. Litteraturstudiens resultat kan ge vårdpersonal ökad kunskap om hur det är att leva med anorexia nervosa och därmed få bättre förutsättningar för att ge stöd och god omvårdnad.

  • 1819.
    Söderholm, Anna
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Söderberg, Anna
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nordin, Steven
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    The experience of living with sensory hyperreactivity: accessibility, financial security, and social relationships2011In: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 32, no 8, p. 686-707Article in journal (Refereed)
    Abstract [en]

    Odor intolerance is a frequently reported problem, predominantly among women. Our purpose was to illuminate how individuals living with sensory hyperreactivity (SHR; a form of odor intolerance) experience its impact on accessibility, financial security, and social relationships. Data were collected by having 12 women with SHR write descriptive texts. These texts were analyzed with qualitative content analysis. Six themes were identified: Being limited in participating in society, being forced to behave incompatibly with one’s personality, experiencing lack of understanding and respect from others, experiencing insecurity, being dependent on others, and being forced to choose between the plague and cholera.

  • 1820.
    Söderlund, Annika
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Svensson, Lisa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sjuksköterskors erfarenheter av icke farmakologiska omvårdnadsåtgärder för att lindra barns smärta: En litteraturstudie2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Pain is a complex phenomenon and the experience of pain is influenced by various factors such as the child's age and earlier experiences of medical procedures. Children who come in contact with healthcare are often exposed to painful procedures and one negative experience may affect the child in the future. The healthcare personnel can use non-pharmacological methods to ease children’s pain.

    Aim: To illuminate nurses' experiences of non-pharmacological nursing actions to alleviate children's pain

    Methods: A literature study based on eight qualitative studies, which were quality controlled and analysed by using context analysis. Four different databases were used in search for the studies included in this literature study.

    Results: The theme that emerged was that there is no universal solution for non-pharmacological pain relief. The theme is presented in three categories: Social interaction is significant, Non-pharmacological pain relief is challenging, The context affects the pain relief.

    Conclusion: This literature study shows the importance of a good relationship and communication customized to fit the child. Experience and knowledge about non-pharmacological nursing actions to alleviate children's pain may improve the nurses' pain-relieving care and reduce children's suffering.

  • 1821.
    Söderlund, Mattias
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Mattsson, Johannes
    Umeå University, Faculty of Medicine, Department of Nursing.
    Andningsbesvär under transport: En studie om skillnader och likheter i vitalparametrar och omvårdnadsåtgärder av äldre patienter med andningsbesvär, vid ambulanstransporter med olika transportprioriteter.2015Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Äldre patienter med andningsbesvär är en vanlig patientkategori inom ambulanssjukvården. Är det någon skillnad på patienters vitalparametrar eller givna läkemedel vid ambulanstransporter med prio 1 och prio 2. 43 ambulans och akutjournaler studerades retrospektivt. 24 prio 1 och 19 prio 2. Patienter som transporterats med prio 1 hade signifikant sämre värden på andningfrekvens, puls och kroppstemperatur. Det erhöll även syrgas i en betydligt större mängd. Merparten av prio 1 patienterna blev triagerade som röda, det vill säga livshotande sjuka. De äldre patienter med andningsbesvär som transporteras i ambulans med prio 1 är enligt studien betydligt sjukare än de som transporteras med prio 2.   

  • 1822.
    Söderlund, Mona
    et al.
    Department of Health Care Sciences, Ersta Sköndal University College, Stockholm.
    Cronqvist, Agneta
    Department of Health Care Sciences, Ersta Sköndal University College, Stockholm.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Health Care Sciences, Ersta Sköndal University College, Stockholm; Palliative Research Centre, Ersta Sköndal University College & Ersta Hospital, Stockholm.
    Ternestedt, Britt-Marie
    Department of Health Care Sciences, Ersta Sköndal University College.
    Hansebo, Görel
    Department of Health Care Sciences, Ersta Sköndal University College, Stockholm.
    Conversations between persons with dementia disease living in nursing homes and nurses: qualitative evaluation of an intervention with the validation method2016In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 30, no 1, p. 37-47Article in journal (Refereed)
    Abstract [en]

    Living with dementia disease (DD) can include difficulties describing experiences of everyday lives, which can lead to withdrawal, social isolation or existential homelessness. Persons with DD living in nursing homes are mainly dependent on the nurses for establishing and maintaining relationships with those around them. It can be challenging for nurses to understand what a person with DD is trying to express and to make themselves understood in turn. The validation method is intended to facilitate communication with persons with DD, but to our knowledge, there have been no qualitative studies of how this influences persons' communication. This study aimed to illuminate the actions and reactions of persons with DD living in nursing homes in one-to-one conversations with nurses during 1 year of validation method training, as observed in videotapes. Four persons with DD were involved in videotaped conversations with four nurses who were participating in a validation method training programme. Videotapes with at least 5 months between the first and last recording were analysed and compared qualitatively. The findings are presented in four categories that were identified to various degrees in conversations at the beginning and at the end of the programme: being uninterested in or unable to answer questions, talking about more than one topic of conversation at the same time, trying to talk about what is on one's mind and speaking more freely about what is on one's mind. In the videotaped conversations at the end of the programme, the persons had the opportunity to use their remaining communication abilities. This may have been related to the development of the nurses' communication skills during the training programme, and so it is possible that persons with DD could benefit from communicating with nurses trained in the validation method.

  • 1823. Söderlund, Mona
    et al.
    Cronqvist, Agneta
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Ternestedt, Britt-Marie
    Hansebo, Görel
    Nurses’ movements within and between various paths when improving their communication skills: an evaluation of validation method training2013In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 3, no 2, p. 265-273Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To explore any changes in nurses’ skills at communicating with residents with dementia disease when using the validation method, as observed in one-to-one videotaped conversations.

    Background: Communication difficulties due to cognitive impairment among residents with dementia disease may complicate care situations. Training can improve nurses’ communication skills and increase care quality. The validation method aims to facilitate communication with residents with dementia disease through empathic and confirmatory approaches. Evaluations of the validation method have primarily focused on the residents’ perspective, and reports on nurses’ experiences are sparse. Improved communication and relationships with residents after validation method training have been described previously. Videotaped data could provide additional information about these earlier results.

    Design: A descriptive qualitative design.

    Methods: Eight nurses participated in a year of validation method training, including videotaped conversations with eleven residents. Videotapes with at least five months between the first and last recording were analysed and compared qualitatively.

    Results: The analysis revealed an overall pattern: nurses’ movements within and between various paths when improving their communication skills. This was based on three sub-patterns: from controlling communication towards developing attentiveness in communication, from ambiguous communication towards developing coherence in communication, and from being open and attentive towards having a refined attuned communication.

    Conclusions: All nurses developed their communication skills during the programme, albeit to different degrees. The findings are in congruence with the experiences described by nurses, and so it is reasonable to believe that the programme helped to improve the nurses’ skills in communicating with residents with dementia disease.

    Relevance to clinical practice: A validation method training programme could give nurses the possibility to develop their skills in communicating with residents with dementia disease.

  • 1824. Söderlund, Mona
    et al.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing. Ersta Sköndal University College.
    Hansebo, Görel
    Implementation of the validation method: nurses’ descriptions of caring relationships with residents with dementia disease2012In: Dementia, ISSN 1471-3012, E-ISSN 1741-2684, Vol. 11, no 5, p. 569-587Article in journal (Refereed)
    Abstract [en]

    This study describes nurses’ experiences of relationships with residents with dementia disease (1) before and after validation method (VM) training and (2) after extensive experience using the VM. An intervention was performed in a nursing home, involving supervision plus one year of training in using the VM. Nurses were interviewed before and after the intervention. Nurses with extensive VM experience, working at another nursing home, were interviewed once. Qualitative content analysis of the transcribed interviews revealed four themes with sub-themes. Most nurses participating in the intervention described a changed approach afterwards, focusing more on residents and on their communications, which in turn seemed to lead to closer, more trusting relationships. A similar approach was described by the nurses with extensive VM experience. One conclusion is that supervised VM training facilitated nurses’ development of communication skills and abilities to establish close relationships with residents. Some nurses described the VM as demanding.

  • 1825. Söderlund, Mona
    et al.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hansebo, Görel
    Validation method training: nurses' experiences and ratings of work climate2014In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 9, no 1, p. 79-89Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Training nursing staff in communication skills can impact on the quality of care for residents with dementia and contributes to nurses' job satisfaction. Changing attitudes and practices takes time and energy and can affect the entire nursing staff, not just the nurses directly involved in a training programme. Therefore, it seems important to study nurses' experiences of a training programme and any influence of the programme on work climate among the entire nursing staff. AIMS AND OBJECTIVES: To explore nurses' experiences of a 1-year validation method training programme conducted in a nursing home for residents with dementia and to describe ratings of work climate before and after the programme. DESIGN: A mixed-methods approach. METHODS: Twelve nurses participated in the training and were interviewed afterwards. These individual interviews were tape-recorded and transcribed, then analysed using qualitative content analysis. The Creative Climate Questionnaire was administered before (n = 53) and after (n = 56) the programme to the entire nursing staff in the participating nursing home wards and analysed with descriptive statistics. RESULTS: Analysis of the interviews resulted in four categories: being under extra strain, sharing experiences, improving confidence in care situations and feeling uncertain about continuing the validation method. The results of the questionnaire on work climate showed higher mean values in the assessment after the programme had ended. CONCLUSION: The training strengthened the participating nurses in caring for residents with dementia, but posed an extra strain on them. These nurses also described an extra strain on the entire nursing staff that was not reflected in the results from the questionnaire. The work climate at the nursing home wards might have made it easier to conduct this extensive training programme. IMPLICATIONS FOR PRACTICE: Training in the validation method could develop nurses' communication skills and improve their handling of complex care situations.

  • 1826.
    Söderlund, Sarah
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundmark, Tommy
    Umeå University, Faculty of Medicine, Department of Nursing.
    Strålskydd för barn vid konventionell röntgen: En litteraturstudie2014Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Research shows that children are more sensitive to ionizing radiation than adults. X-ray imaging may not be performed unnecessarily and its necessity must exceed the risks. It is important to optimize the imaging and as far as possible minimize the radiation dose without affecting the diagnostic performance negatively. Research shows that even low doses of radiation can cause DNA damage and ultimately induce cancer. Objective: The aim of this paper was to describe methods that optimize the x-ray examination and reduce radiation doses to children in conventional radiography. Method: A literature study whose results are based on 14 scientific articles found in the databases PubMed and CINAHL and manual searches. Results: There were several methods that optimize the x-ray examination and reduce the radiation doses to children in conventional radiography. These methods concern approaches in the examination room, parameters, filtering and new technology. Conclusion: Radiographers’ with knowledge of optimization have good opportunities to lower radiation doses in x-ray examinations of children in conventional radiography.

  • 1827. Söderström, Ing-Mari K
    et al.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hagberg, Margaretha S
    Benzein, Eva G
    Family adaptation in relation to a family member's stay in ICU2009In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 25, no 5, p. 250-257Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To describe and interpret the family adaptation during the ICU hospitalisation and up to 18 months after discharge. RESEARCH METHODOLOGY/DESIGN: A qualitative design was chosen. MAIN OUTCOME MEASURES: Individual and family interviews with eight families including 31 family members. A hermeneutical analysis was performed and paradigm cases were constructed. RESULTS: The result is presented in three themes: striving for endurance, striving for consolation and striving to rebuild life under new conditions. The family adaptation started at the onset of the critical incident and continued during the ICU stay and after discharge. The family members metaphorically went through peaks and valleys during the whole process of adaptation. CONCLUSION: Adaptation is an issue for the whole family and is facilitated by being able to stay close to the patient and receive supportive unambiguous information from the staff both during the ICU stay and after discharge.

  • 1828.
    Sörberg, Martin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Patienters upplevelse av preoperativ information gällande luftvägshantering samt postoperativa halsbesvär: En intervjustudie2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Information is an important part of the nurse anesthetist’s encounterwith the patient. Information as a tool, aims for a better care and safety for the patient. During an anesthesia, the patients airway and breathing is controlled, wherein sore throat and hoarsness can occur post operative. Post operative sore throat and hoarsness are common and affect many patients. Giving preoperative information regarding airway management and probable postoperative sore throat inconvenience, can be of importance of the patients well-being.

    Objectives: To analyze patients experiences of preoperative information regarding airway management and postoperative throat inconvenience.

    Methods: Qualitative interviews study. 8 semi structured interviews, were conducted on patients who had been operated in general anesthesia.

    Results: The interviews resulted in three different categories with respectively sub categories. Feelings before surgery; in a stressful situation the patients felt confidence and trust, and also that calm and safety were submitted. The importance of estimating amount of information; some experienced too much information, others too little and that it is important with personalized information, fitted for what each and other patient wants to know. Means of information; where, when and how the information is given, affects the patients. Continious and concised information, with opportunity to ask questions, is experienced as positive.

    Conclusions: Patients are different and reacts different on the amount of information and means of information. It is therefor important to adjust the amount of information and to give personalized information suited for each and other patient. Given thorough information about airway management is experienced by some patients as unpleasant. Given information about postoperative throat inconvenience soothes.Keywords preoperative information; airway management; postoperative throatinconvenience; feelings; amount of information; means of information.

  • 1829. Sørbye, Liv W
    et al.
    Hamran, Torunn
    Henriksen, Nils
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Home care patients in four Nordic capitals: predictors of nursing home admission during one-year followup2010In: Journal of multidisciplinary healthcare, ISSN 1178-2390, Vol. 3, p. 11-18Article in journal (Refereed)
    Abstract [en]

    The aim was to predict nursing home admission (NHA) for home care patients after a 12-month follow-up study. This Nordic study is derived from the aged in home care (AdHOC) project conducted in 2001–2003 with patients at 11 sites in Europe. The participants in the cohort study were randomly selected individuals, aged 65 years or older, receiving homecare in Oslo, Stockholm, Copenhagen, and Reykjavik. The Resident Assessment Instrument for Home Care (version 2.0) was used. Epidemiological and medical characteristics of patients and service utilization were recorded for 1508 home care patients (participation rate 74%). In this sample 75% were female. The mean age was 82.1 (6.9) years for men and 84.0 (6.6) for women. The most consistent predictor of NHA was receiving skilled nursing procedures at baseline (help with medication and injections, administration or help with oxygen, intravenous, catheter and stoma care, wounds and skin care) (adjusted odds ratio = 3.7, 95% confidence interval: 1.7–7.8; P < 0.001). In this Nordic material, stronger emphasizing on higher qualified nurses in a home care setting could prevent or delay NHA.

  • 1830. Talabani, Naghada
    et al.
    Hellström Ängerud, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Research Unit Skellefteå, Department of Medicine, Umeå University, Skellefteå, Sweden.
    Brännström, Margareta
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University. Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
    Patients' experiences of person-centred integrated heart failure care and palliative care at home: an interview study2017In: BMJ Supportive & Palliative Care, ISSN 2045-435X, E-ISSN 2045-4368Article in journal (Refereed)
    Abstract [en]

    Objectives Patients with severe heart failure (HF) suffer from a high symptom burden and high mortality. European and Swedish guidelines for HF care recommend palliative care for these patients. Different models for integrated palliative care and HF care have been described in the literature. No studies were found that qualitatively evaluated these models. The purpose of this study is to describe patients' experiences of a new model of person-centred integrated HF and palliative care at home.

    Method Interviews were conducted with 12 patients with severe HF (New York Heart Association class III–IV) and included in the research project of Palliative advanced home caRE and heart FailurE caRe (PREFER). Qualitative content analysis was used for data analysis.

    Results Two themes and a total of five categories were identified. The first theme was feeling secure and safe through receiving care at home with the categories: having access to readily available care at home, being followed up continuously and having trust in the team members' ability to help. The second theme was being acknowledged as both a person and a patient, with the following two categories: being met as a person, participating in decisions about one's care and receiving help for symptoms of both HF and comorbidities.

    Conclusions Person-centred integrated HF and palliative care provides a secure environment and holistic care for patients with severe HF. This approach is a way to improve the care management in this population.

  • 1831.
    Talseth, Anne-Grethe
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Psychiatric care of people at risk of committing suicide: narrative interviews with registered nurses, physicians, patients and their relatives2001Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aims of this thesis are to illuminate the meaning of being cared for and treated by nurses and physicians, as narrated by psychiatric suicidal in-patients; the meaning of taking care of and treating patient at risk of committing suicide, as narrated by nurses and physicians; and the meaning of being met and having one’s suicidal relative taken care of by health personnel, as narrated by relatives. Narrative interviews were conducted with 42 adult patients at risk of committing suicide in an in-patient psychiatric unit, 19 RNs, 19 physicians, and 15 relatives at a hospital in Norway. The tape-recorded and transcribed interviews were interpreted using a phenomenological hermeneutic method.

    Nurses’ relations to patients at risk of committing suicide were illuminated via the dimension ‘Distance- Closeness’ (I). The relation of the suicidal patient to the nurses was illuminated via the dimension ‘Confirming- Lack of confirming’ (II). The relation of physicians to patients was illuminated via the dimension ‘Power to - Power over’. (III). The relation of suicidal patients to physicians was illuminated via the dimension ‘Participating approach-Observing approach’ (TV). Results from the relatives’ experiences of being met by health personnel of suicidal patients reveal that the context of being met was characterized by ‘being helpless-powerless’, and that the meaning of the experiences of ‘being met’ was reflected in six themes: ‘Being seen as a human being’; ‘Participating in an I-Thou relationship with personnel’; ‘Trusting personnel, treatment and care’; ‘Being trusted by personnel’; ‘Being consoled’; and ‘Entering into hope’ (V).

    The interpreted meanings of the experience of being cared for as a person at risk of committing suicide were illuminated as confirmation, communion, consolation and hope. Threaded through these meanings is the relation with self and others. Thus, the essence of the results that emerged from this study indicates the presence of a relational view of the care received by people at risk of committing suicide.

  • 1832. Talseth, Anne-Grethe
    et al.
    Gilje, Fredricka L.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nurses' responses to suicide and suicidal patients: a critical interpretive synthesis*2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 11-12, p. 1651-1667Article, review/survey (Refereed)
    Abstract [en]

    Aims and objectives. To provide an inclusive understanding of nurses' responses to suicide and suicidal patients that can benefit nursing practice and guide research. The question was 'What is a critical interpretive synthesis of accumulated nursing research on nurses' responses to suicide and suicidal patients?' Background. Various studies address nurses' responses to suicide and suicidal patients. An understanding of accumulated research-based literature about nurses' responses to suicide and suicidal patients may guide nurses to care for suicidal patients in ways that facilitate suicide prevention and recovery. Design. The design is reflexive and iterative. Method. A Critical Interpretive Synthesis was conducted, which comprised of six phases: formulating the review question, searching the literature, sampling, determining quality, extracting data and conducting an interpretive synthesis. Qualitative content analysis and systematic review of literature was included in these phases. Results. The results report the review question, literature review strategies, purposive sample (26 full-text studies published in peer reviewed journals, 1988-July 2009, conducted mostly in Europe and North American), quality determinants, data extraction into themes and an interpretive synthesis of four key concepts, i.e. critical reflection, attitudes, complex knowledge/professional role responsibilities, desire for support services/resources. Conclusion. This understanding of accumulated research-based literature enhances contextual, conceptual and methodological perspectives. Contextually, gaps exist in international research. Conceptually, the four key concepts can serve as a useful guide for nurses to understand their own and other nurses' responses to caring for suicidal patients in various settings. Methodologically, the Critical Interpretive Synthesis approach moved a small body of knowledge that varied in quality measures beyond an aggregate understanding. Relevance to clinical practice. Understanding nurses' responses to suicide and suicidal patients may guide nurses to care for suicidal patients in ways that facilitate suicide prevention and recovery, thus addressing the urgent work of suicide prevention in the world.

  • 1833.
    Teglund, Elin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Faye, Adam
    Umeå University, Faculty of Medicine, Department of Nursing.
    Erfarenheter av att vårda personer med Hiv/Aids2015Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Vårdpersonal kan uppleva negativa erfarenheter när de vårdar personer med HIV/AIDS. Det framkommer i studier att kunskap om HIV/AIDS kan leda till positivare erfarenheter. Vårdpersonals erfarenheter av att vårda dessa personer är därför en viktig kunskap som kan användas för att förbättra kunskapen hos vårdpersonal och i längden förbättra vården för personer med HIV/AIDS.

    Syfte: Litteraturstudiens syfte var att beskriva vårdpersonals erfarenheter av att vårda personer med HIV/AIDS.

    Metod: Litteraturstudie där åtta kvalitativa vetenskapliga studier inkluderades. Fribergs modell för litteraturöversikt användes och med inspiration från Graneheim och Lundman (2004) granskades studiernas resultat. Dessa analyserades och sammanställdes till nya resultat.

    Resultat: Resultatet sammanställdes i sex underkategorier som beskrev vårdpersonalens erfarenheter av att vårda personer med HIV/AIDS. Dessa sex underkategorier delades i sin tur in i två kategorier: Känslor av sympati, vanmakt, rädsla och ilska och Upplevelse av stigma och diskriminering.

    Slutsats: Bristande kunskap om sjukdomstillståndet HIV/AIDS kan leda till ett fördömande och stigmatisering mot personerna med sjukdomen och kan relateras till samhället och den syn som redan finns mot personer med HIV/AIDS. Mer kunskap om HIV/AIDS hos vårdpersonal kan hjälpa dem att få mer positiva erfarenheter vilket kan påverka omvårdnaden för personerna med sjukdomen.

  • 1834.
    Tekle, Mikal
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Svedhammer, Sofia
    Umeå University, Faculty of Medicine, Department of Nursing.
    Skolpersonals erfarenheter av att identifiera omsorgssvikt hos skolbarn: -En intervjustudie utifrån ett instrument2018Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Schoolnurses and other school professionals are obliged to report suspicion that a child is treated badly or suffers from neglect or abuse. Almost every fourth child is reported in accordance with the notification obligation. Previous research shows that insecurity is common when it comes to identifying signs of maltreatment in school children.

    Motive: At present, there is a lack of uniform knowledge for staff to use in order to pay attention to childhood maltreatment and abuse in school-age children. Currently existing instruments focuses primarily on physical injuries as well as on younger children.

    Aim: The purpose of the study was to identify school staff's perceptions of childhood maltreatment in children 6-15 years old and to study the applicability of a tool for screening.

    Methods: Phenomenographic approach with structured “think-aloud” interviews based on a questionnaire and RPM validation of instrument content.

    Result: The study shows that school staff have insufficient knowledge about signs of maltreatment, supported by both qualitative and quantitative analysis. The study also shows that an instrument can provide support for identifying children exposed to maltreatment. School staff perceive maltreatment through four qualitatively different ways that interact with each other; By Observing, By Listening, Through Reflection and Through Consciousness.

    Discussion: Staff found it difficult to identify maltreatment. The difficulties were mainly due to the lack of overall picture of the child due to lack of time and little contact with the parents. It was also due to hidden maltreatment and lack of common knowledge. It was found that an instrument for detecting maltreatment could support the staff, primarily by express their suspicions.

    Conclusion: The study shows that an instrument supports staff in their work and can strengthen the staff in their mission to carry out an alert. Hopefully, the study can be a part of designing a unified theoretical knowledge base and common framework regarding awareness about childhood neglect or abuse.

  • 1835.
    Teliceanu, Gianina
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nyman, Andrea
    Umeå University, Faculty of Medicine, Department of Nursing.
    Patientutbildning som omvårdnadsåtgärd för att minska cancerrelaterad fatigue2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 1836.
    Thiger, Helena
    Umeå University, Faculty of Medicine, Department of Nursing.
    "Jag är inte tjock, jag är gravid!": Sex gravida kvinnors självbild under graviditeten - en intervjustudie.2015Independent thesis Advanced level (degree of Master (One Year)), 60 credits / 90 HE creditsStudent thesis
    Abstract [en]

    Abstract

    Background: A pregnancy forces the female body to change. Today we can identify clearly defined feminine ideal, during the time of pregnancy the body change in the direct opposite direction to societal trends which causes the pregnant women to question their self-image. The pregnancy causes the women to feel ugly and unattractive. However, feeling the baby´s hiccups or kicks make women fascinated and full of pride.

    Objective: The aim of the present study was to illustrate how women describe their self-image during pregnancy

    Methods: Semi-structured open-ended interviews were conducted with a total of six women who were pregnant in week 28-35. Data were analyzed inspired of grounded theory.

    Results: The analysis presented one main code, four categories and sixteen subcategories. Pregnant women have in general a poor self-image as a result of the society's ideal about the female body. Despite the negative feelings towards the body the women actively tried to strive for a positive experience with help of small appliances. The women expressed a greater need for support from their partners, families and friends to accept and cope with the stressful mental strain that the pregnancy creates. The midwives had a good medical knowledge but lacked empathy, which caused the women to feel neglected.

    Conclusion: The pregnant women had in generally a poorer self-image as a result of the body ideal in society. Acceptance of the pregnant self-image could be accomplished with a good relation to their own body. Also support from partners and families were the main components for a good ability to adapt oneself to pregnancy.

  • 1837.
    Thomée, Suzanne
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Malm, Desiré
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Christianson, Monica
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Wiklund, Maria
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Waenerlund, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Challenges and strategies for sustaining youth-friendly health services: a qualitative study from the perspective of professionals at youth clinics in northern Sweden2016In: Reproductive Health, ISSN 1742-4755, E-ISSN 1742-4755, Vol. 13, article id 147Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Youth-friendly health-care services - those that are accessible, acceptable, equitable, appropriate and effective for different youth subpopulations - are beneficial for youth health, but not easy to implement and sustain. Sweden is among the few countries where youth-friendly health-care services have been integrated within the public health system and sustained for a long time. This study explores the challenges and strategies in providing sustainable youth-friendly health-care services, from the perspective of professionals working in youth clinics in northern Sweden.

    METHODS: Eleven semi-structured interviews with various health-care professionals working in youth clinics in northern Sweden were conducted. The interviews were transcribed verbatim, and analysed using thematic analysis in relation to the World Health Organization domains of youth friendliness.

    RESULTS: Four themes emerged from the analysis of the data: 1) 'Meeting youths on their own terms - the key to ensuring a holistic and youth-centred care' was related to the acceptability and appropriateness of the services; 2) 'Organizational challenges and strategies in keeping professionals' expertise on youth updated' referred to the domain of effectiveness; 3) 'Youth clinics are accessible for those who know and can reach them' was related to the domains of accessibility and equity, and 4) 'The challenge of combining strong directions and flexibility in diverse local realities' focused on the struggle to sustain the youth clinics organization and their goals within the broader health system.

    CONCLUSIONS: Professionals working in youth clinics are perceived as motivated, interested and knowledgeable about youth, and the clinics ensure confidentiality and a youth-centred and holistic approach. Challenges remain, especially in terms of ensuring equitable access to different youth subpopulations, improving monitoring routines and ensuring training and competence for all professionals, independently of the location and characteristics of the clinic. Youth clinics are perceived as an indisputable part of the Swedish health system, but organizational challenges are also pointed out in terms of weak clear directives and leadership, heavy workload, local/regional diversity and unequitable distribution of resources.

  • 1838.
    Thuveson, Lina
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Larsson, Jennie
    Umeå University, Faculty of Medicine, Department of Nursing.
    Kvinnors upplevelse av barnmorskans stöd vid förlossningsrelaterad rädsla2012Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 1839. Thylén, Ingela
    et al.
    Brännström, Margareta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Intimate relationships and sexual function in partnered patients in the year before and one year after a myocardial infarction: A longitudinal study2015In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 14, no 6, p. 468-477Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Intimate relationships and sexuality are essential to an individual's health and longevity after a myocardial infarction (MI).

    AIMS: To explore and compare partnered first-time MI patients' ratings of intimate relationship satisfaction and sexual function before the MI as compared to one year after the event.

    METHODS: Longitudinal study with 92 men and 36 women, aged 62.4±9.3 years. Self-reported data was collected one year before, and one year after, the MI.

    RESULTS: The majority were sexually active before (86%) as well as after (80%) their MI (ns). High satisfaction was reported with intimate relationships, which were stable over time (Relationship assessment scale score 4.56±0.50 and 4.53±0.52, respectively, ns). No significant differences in intimate relationships between genders were found. Women reported lower ratings in their sexual function than men before the MI (Watts sexual function score 45.92±6.55 and 48.59±4.96, respectively, P<0.05). The year after the event, women described an unchanged sexual function (45.08±7.25), while men (47.10±5.16) had decreased theirs (P<0.05). Both female and male patients enjoyed sexual activity less frequently the subsequent year. Men regarded having sex as being less important in their lives, were less satisfied with the frequency of sexual activity, and felt that they more often ejaculated prematurely the year after the MI.

    CONCLUSIONS: Partnered first-time MI patients continue to be sexually active the year after the event, and are highly satisfied with their intimate relationship. While the MI event seems to have a more negative impact on men's sexual functioning than women's, the women still rate their sexual function lower in comparison.

  • 1840. Thylén, Ingela
    et al.
    Ericsson, Maria
    Hellström Ängerud, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Isaksson, Rose-Marie
    Sederholm Lawesson, Sofia
    First medical contact in patients with STEMI and its impact on time to diagnosis: an explorative cross-sectional study2015In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 5, no 4, article id e007059Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: It is unknown into what extent patients with ST-elevation myocardial infarction (STEMI) utilise a joint service number (Swedish Healthcare Direct, SHD) as first medical contact (FMC) instead of Emergency Medical Services (EMS) and how this impact time to diagnosis. We aimed to (1) describe patients' FMC; (2) find explanatory factors influencing their FMC (ie, EMS and SHD) and (3) explore the time interval from symptom onset to diagnosis.

    SETTING: Multicentred study, Sweden.

    METHODS: Cross-sectional, enrolling patients with consecutive STEMI admitted within 24 h from admission.

    RESULTS: We included 109 women and 336 men (mean age 66±11 years). Although 83% arrived by ambulance to the hospital, just half of the patients (51%) called EMS as their FMC. Other utilised SHD (21%), contacted their primary healthcare centre (14%), or went directly to the emergency room (14%). Reasons for not contacting EMS were predominantly; (1) my transport mode was faster (40%), (2) did not consider myself sick enough (30%), and (3) it was easier to be driven or taking a taxi (25%). Predictors associated with contacting SHD as FMC were female gender (OR 1.92), higher education (OR 2.40), history of diabetes (OR 2.10), pain in throat/neck (OR 2.24) and pain intensity (OR 0.85). Predictors associated with contacting EMS as FMC were history of MI (OR 2.18), atrial fibrillation (OR 3.81), abdominal pain (OR 0.35) and believing the symptoms originating from the heart (OR 1.60). Symptom onset to diagnosis time was significantly longer when turning to the SHD instead of the EMS as FMC (1:59 vs 1:21 h, p<0.001).

    CONCLUSIONS: Using other forms of contacts than EMS, significantly prolong delay times, and could adversely affect patient prognosis. Nevertheless, having the opportunity to call the SHD might also, in some instances, lower the threshold for taking contact with the healthcare system, and thus lowers the number that would otherwise have delayed even longer.

  • 1841.
    Thyme, Karin Egberg
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Wiberg, Britt
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Qualitative content analysis in art psychotherapy research: concepts, procedures, and measures to reveal the latent meaning in pictures and the words attached to the pictures2013In: The arts in psychotherapy, ISSN 0197-4556, E-ISSN 1873-5878, Vol. 40, no 1, p. 101-107Article in journal (Refereed)
    Abstract [en]

    The aim of this methodological paper is to describe and apply qualitative content analysis to a psychodynamic art psychotherapy context, and to give an example of the procedures used to analyse pictures and words in one time-limited psychodynamic art psychotherapy session, here named PDT/Scribbling. The art method was used with a female patient. Qualitative content analysis was used to analyse one scribble with its amplification together with the patient's own clarifying words explaining the pictures. In addition, the words spoken before and after scribbling were analysed in order to capture the whole psychotherapeutic process. In the application we coded and categorised colours and elements of the scribbles and amplifications, which together with categories of the patient's own words before and after scribbling resulted in three sub-themes and an overarching theme: permitting herself to leave a victim position and take charge of her life. The conclusion of this methodological paper is that qualitative content analysis is a meaningful method for analysing pictures and words from psychodynamic art psychotherapy sessions, keeping the manifest messages and the latent meanings in the pictures intact.

  • 1842.
    Tibaduiza, Gelnis
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren, Elena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Kvinnors erfarenheter av att drabbas av hjärtinfarkt2013Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund:

    Hjärt-och kärlsjukdomar är den vanligaste dödsorsaken bland både män och kvinnor i Sverige. I flera andra länder ökar mortaliteten i hjärtinfarkt bland kvinnor. Många kvinnor ser fortfarande hjärtinfarkt som i huvudsak en manlig åkomma. Att drabbas av en hjärtinfarkt innebär för den drabbade ett livshotande tillstånd i vilken varje minut räknas

    Syfte:

    Syftet med studien är att beskriva kvinnors upplevelse och agerande i samband med insjuknande av hjärtinfarkt.

    Metod:

    I litteraturstudien har8 vetenskapliga artiklargranskats som överensstämmer med studiens syfte. Artiklarna har analyserats utifrån en innehållsanalytisk metod. Alla artiklar i studien var kvalitativt designade.

    Resultat:

    I samband med hjärninfarkt visade kvinnor svårigheter att associera symtom med en hjärtinfarkt. Många saknade kunskap om de kliniska symptom kvinnor kan uppleva vid en hjärtinfarkt. Bilden som massmedia visar om hjärtinfarkt påverkade kvinnors uppfattning av symtom. Det råder fortfarande en uppfattning bland kvinnor att hjärtinfarkt drabbar främst män. Anhöriga verkarhastor betydelse i beslutet att söka vård.

    Slutsats:

    Det behövs mer information till allmänheten om de kliniska symtomen på hjärtinfarkt bland kvinnor och att dessakan skilja sig det från männen symtom. Massmedias bildav hjärtinfarkt bör ses med kritiska ögon.

     

  • 1843.
    Tieva, Linda
    Umeå University, Faculty of Medicine, Department of Nursing.
    Ha rätt verktyg för att våga öppna Pandoras ask. En intervjustudie med barnmorskor om att ställa frågan om våldsutsatthet.2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Objective: To explore midwive´s experiences of posing questions about intimate partner violence according to national guidelines.Design: Interview study with individual semi-structured interviews using qualitative content analysis for analysis.Setting: Five antenatal clinics in northern Sweden.Participants: Nine midwives, working in public and private antenatal care clinics. Midwives aged 34 to 62 years with experiences in antenatal health care as well as delivery care participated. All participants gave their verbal and written concent to participate in the study.Results: Participants´ experiences working with support of the guidelines and terms of intimate partner violence can be summed up in the overarching theme: Need to have the right tools to dare open Pandora´s box. The categories: Lack of opportunities to work in a good way, Overcoming barriers, Manage your own emotions and Feel safety and support when work feels difficult described different aspects of experiences.Conclusion: Although the guidelines are perceived as supporting the work study showed that the issue of violence can be difficult to make because of the different circumstances. The midwife can then choose to refrain from asking or defer the matter to a later date in the case despite awareness that she should ask the question.Clinical implications: More education and training is needed to increase midwives security in violence prevention work. The guidelines need to be developed and improved in order to reduce uncertainty at various dilemmas when the midwife to ask about intimate partner violence.

  • 1844.
    Tinnfält, Ingrid
    et al.
    Hälsoakademin Örebro Universitet .
    Nilsson, Ulrica
    Umeå University, Faculty of Medicine, Department of Nursing.
    Patients' experiences of the intraoperative care during abdominal aortic aneurysm repair in local anaesthesia2011In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 26, no 2, p. 81-88Article in journal (Refereed)
    Abstract [en]

    Abdominal aortic aneurysms can be repaired using endovascular surgery performed under local anesthesia. However, evidence is sparse concerning how patients experience intraoperative care while being “awake” during major surgery. The primary aims of this retrospective study were to identify patients’ perceptions of the quality of intraoperative care during endovascular surgery for aortic aneurysm under local anesthesia and to identify areas for quality improvement. Retrospectively, 26 patients completed the questionnaire “Quality From the Patient’s Perspective.” The results showed that 15 of 21 total items received scores above the quality improvement threshold. Patients rated the quality of intraoperative nursing to be very high in terms of how they experienced the situation and nurses’ understanding, confidence, commitment, and respect. However, need for improvement was found in four areas: participation, pain, anxiety, and positioning. In conclusion, despite the need for quality improvement in four identified areas, patients undergoing endovascular aneurysm repair under local anesthesia appear to perceive the quality of intraoperative care, especially nursing, as high.

  • 1845. Tishelman, Carol
    et al.
    Lindqvist, Olav
    Umeå University, Faculty of Medicine, Department of Nursing.
    Going Public: Integrating Palliative Care, Health Promotion and Public Health in Sweden Through the DöBra Research Program2016In: Journal of Pain and Symptom Management, ISSN 0885-3924, E-ISSN 1873-6513, Vol. 52, no 6, p. E19-E19Article in journal (Refereed)
  • 1846. Tishelman, Carol
    et al.
    Lindqvist, Olav
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hajdarevic, Senada
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Rasmussen, Birgit H.
    Umeå University.
    Carlander, Ida
    Space and Place for End-of-Life Care: A Photo-Elicitation Study2014In: Journal of Palliative Care, ISSN 0825-8597, Vol. 30, no 3, p. 220-220Article in journal (Refereed)
  • 1847. Tishelman, Carol
    et al.
    Lindqvist, Olav
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Learning, Informatics, Management and Ethics, Medical Management Center, Karolinska Institutet, SE-171 77 Stockholm Sweden.
    Hajdarevic, Senada
    Umeå University, Faculty of Medicine, Department of Nursing.
    Rasmussen, Birgit H
    Goliath, Ida
    Beyond the visual and verbal: Using participant-produced photographs in research on the surroundings for care at the end-of-life.2016In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 168, p. 120-129Article in journal (Refereed)
    Abstract [en]

    The web of relationships between wellbeing and the environments in which people live has long been recognized. However, relatively little research has been conducted about end-of-life surroundings from the perspective of the dying person. In this study, we investigate which aspects of their surroundings are particularly meaningful for the people inhabiting them in the last phases of life, based on participant-produced photographs with follow-up interviews. Twenty-three people were purposefully recruited via specialized in-patient palliative care/hospice units, specialized palliative care home care teams, and residential care facilities for the elderly. Participants were given a digital camera, and asked to take pictures of that which was meaningful for them in their surroundings. The interviewer later viewed the photographs with the participant, asking: "what is this picture of?" and "why is it meaningful to you?" The database consists of 76 photographs with follow-up interviews, which were analyzed qualitatively in an iterative process. These empirical data demonstrate how a sense of being valued, and of being able to maintain contacts with one's daily life and sense of identity appear supported or hindered by features of the care surroundings. These features include a positive aesthetic experience incorporating both sensory stimulation using one's body as well as general ambiance; support appropriate for maintaining a sense of functional independence; and connections with one's past, present and future as a person within a wider world. Corporeality appears crucial for understanding, negotiating and interacting in one's surroundings, while maintaining both physical and social function. This data collection approach was found to offer alternative forms of expression as verbal ability decreases and symptom burden increases, making it useful in end-of-life research and practice development.

  • 1848.
    Tjernberg, Caroline
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Wedin, Elin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Patienters upplevelser av hur hemodialysbehandling påverkar livet2014Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
  • 1849.
    Tjernberg, Caroline
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Wedin, Elin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Patienters upplevelser av hur hemodialysbehandling påverkar livet2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Att drabbas av kronisk njursvikt och därmed tvingas börja medhemodialys innebär en stor omställning i livet. Patienterna beskriver många olikakänslor som de måste lära sig att leva med. Relationen till sjuksköterskan är viktigtoch behov av information är stort. Syfte: Syftet med litteraturstudien var att beskrivahur patienter upplever att hemodialys påverkar deras liv. Metod: I litteraturstudienhar 12 kvalitativa empiriska studier sammanställts och analyserats utifrån Fribergsanalysmetod, inspirerad av beskrivande metasyntes. Artikelsökning utfördes idatabaserna Cinahl och Pubmed. Resultat: Patienternas upplevelser delades in i trekategorier, fysiska, psykiska och sociala. Upplevelsen av att behöva hemodialys vartill största delen negativ. Slutsats: Att leva med hemodialys är påfrestande bådefysiskt, psykiskt och socialt och det är därför av stor vikt att både patienter, anhörigaoch vårdpersonal får förståelse för hur patienterna kan uppleva sin situation.

    Nyckelord: Hemodialys, Patient, Upplevelse, Vuxna, Litteraturstudie.

  • 1850.
    Tjärnberg, Jessica
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Kristiansson, Emil
    Umeå University, Faculty of Medicine, Department of Nursing.
    Distriktssköterskans upplevelse av mötet med flyktingar i glesbygd: En intervjustudie2014Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    INTRODUCION Sweden receives a large number of refugees and many of them come to the rural area. A good reception is crucial for the health of the refugees who are entitled to a health assessment, emergency care and care that cannot wait. Cultural differences imply challenges for the health care and primary health care nurses who meet the refugees.

     

    OBJECTIVE The aim of this study was to investigate the factors that affect the experience of primary health care nurses meeting with refugees at community health centers without specific care refugee centers in rural areas.

     

    METHOD The study was performed with a qualitative design. Eight primary health care nurses with experiences working with refugees in rural areas were sampled and interviewed. Data was collected from semi structured interviews and analyzed using qualitative content analysis.

     

    RESULTS A good attitude is important when refugees seek care, and to credence the refugees when they seek health care that cannot wait. Assessments to characterize 'what is care that cannot wait' described as difficult. The knowledge of cultures was expressed as desirable. Prioritizing health assessments were emphasized as important. The assignment in refugee reception is clear, but there is a lack of resources and the wish for knowledge was expressed. Positive development in working with refugees exists and the number of refugees is believed to increase in rural areas. The relationships are perceived more personal in rural areas.

     

    CONCLUSION In rural areas, the meeting felt more personal and primary health care nurses wish to develop and operate transboundary. The refugees have confidence in the nursing staff which enables integration and could be promoted by the primary health care nurses if they saw this as their responsibility and were provided proper resources. Knowledge of trans-cultural nursing is needed today in health care and to develop that it demands the opportunity for reflection and exchange of experiences.

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