Early relationship between very preterm infant and mother: The role of infant, maternal and dyadic factors

Pienipainoisen keskosen ja äidin varhainen suhde: Lapsen, äidin ja dyadisten muuttujien vaikutus Tämän tutkimuksen tavoitteena oli tutkia keskosvauvan ja äidin varhaista suhdetta. Tutkimuksessa selvitettiin myös vauvan itkukäyttäytymisen, vauvan sylissä olon ja äidin masentuneisuuden yhteyttä äidin ja keskosvauvan varhaiseen suhteeseen. Tutkimusryhmät koostuivat 32:sta (tutkimus I-II) ja 38:sta (tutkimus III-IV) keskosena syntyneestä vauvasta (syntymäpaino < 1501 g tai GI < 32 viikkoa) sekä 46:sta täysiaikaisena syntyneestä terveestä verrokkivauvasta. Lapsen ja äidin vuorovaikutusta arvioitiin 6 ja 12 kuukauden iässä (korjattu ikä) PCERAmenetelmällä. Äidin mielikuvia lapsestaan tutkittiin WMCI-haastattelulla, kun lapsi oli 12 kuukautta. Baby Day Diary -menetelmää käytettiin vauvan itkukäyttäytymisen ja sylissä olon keston mittaamisessa vauvan ollessa 5 kuukautta. Äidin masentuneisuutta arvioitiin EDPS-lomakkeella, kun lapsi oli 6 kuukautta. Tulokset osoittivat, että turvallisten kiintymyssuhdemielikuvien määrä tai vuorovaikutuksen laatu eivät keskosvauvan äideillä eronneet täysiaikaisina syntyneiden vauvojen äitien vastaavista. Ryhmien välillä ei löytynyt eroja myöskään dyadisen vuorovaikutuksen laadussa. Keskosena syntyneet lapset olivat kuitenkin vetäytyvämpiä ja heillä oli laadullisesti heikommat keskittymisen ja leikin taidot vuorovaikutustilanteessa 12 kuukauden iässä täysiaikaisina syntyneisiin lapsiin nähden. Lisäksi äidin masentuneisuus ja lapsen pitkittynyt itkuisuus olivat negatiivisessa yhteydessä vuorovaikutuksen laatuun keskosvauvojen ryhmässä. Vauvan itkukertojen määrän, sylissä olon keston sekä äidin ja vauvan vuorovaikutuksen laadun välillä löytyi positiivinen yhteys ainoastaan keskosena syntyneiden lasten ryhmässä. Tulostemme perusteelle toteamme, että lapsen ennenaikainen syntymä itsessään ei näytä muodostavan riskiä äidin vuorovaikutuksen laadulle tai turvalliselle kiintymyssuhteelle. Yhdessä muiden riskitekijöiden kanssa keskosuus kuitenkin altistaa vauvat ja heidän äitinsä varhaisen vuorovaikutuksen ongelmille. Lisäksi tuloksemme viittaavat siihen, että vauvan itku ja siitä seuraava sylissä olo toimivat suojaavana mekanismina pienipainoisen keskosen ja äidin varhaisessa suhteessa.

Målarpoeten Ellen Thesleff : teknik och konstnärligt uttryck

The aim of this thesis has been to illustrate the multifaceted talent in Ellen Thesleff's (1869 - 1954) work with particular emphasis on her technique and artistic expression. Why did Ellen Thesleff work withso many techniques? How did the technique affect the expression and what characterizes it? It would also be of interest to gather some idea of Ellen Thesleff's position among other artists. The investigation covers a representative selection of about 60 pictures, using nine different techniques, primarily as oils, woodcuts and monumental painting. The pictures illustrate three periods of time, the natural (1890 - 1905), the colourful (1906 - 1927) and the free period (1928 -1950). I describe the pictures in regard to their conception and subject matter and scrutinize their formal creation. Thereafter, I investigate the painting technique and artistic expression of each picture and position it, where applicable, in relation to other art. Ellen Thesleff's artistic quality is discussed in relation to her techniques and expression. Thesleff consciously chooses different techniques for related subjects in order to vary the expression. The progressing evolution within individual techniques and a cross-fertilization between them has evidently contributed to raising her artistic quality. I have studied how the techniques influence expression and found it possible to identify certain characteristic styles during the three periods: first a natural painting technique which reminds one of both French realism, paintings reflecting the Nordic mood and atmosphere, and symbolism, ascetism and synthetism; later an expressive Thesleff colourism with brilliant over- and underpainting in contrasting colours and last a free decorative painting in lines, with symbolistic undertones. Most characteristic is the lyrical expression which seems to be a common theme throughout Thesleff's entire artistry. I have found that Ellen Thesleff in her works had herown personal style compared to her contemporaries. Despite deep knowledge of styles and techniques she continually creates art from her inner self and with her own personal brush signature.

Health-related quality of life in school children: validation of instrument, child self assessment, parent-proxy assessment and school nursing documentation of health check-ups

The aims of this study were to validate an international Health-Related Quality of Life (HRQL) instrument, to describe child self and parent-proxy assessed HRQL at child age 10 to 12 and to compare child self assessments with parent-proxy assessments and school nursing documentation. The study is part of the Schools on the Move –research project. In phase one, a cross-cultural translation and validation process was performed to develop a Finnish version of Pediatric Quality of Life Inventory™ 4.0 (PedsQL™ 4.0). The process included a two-way translation, cognitive interviews (children n=7, parents n=5) and a survey (children n=1097, parents n=999). In phase two, baseline and follow-up surveys (children n=986, parents n=710) were conducted to describe and compare the child self and parent-proxy assessed HRQL in school children between the ages 10 and 12. Phase three included two separate data, school nurse documented patient records (children n=270) and a survey (children n=986). The relation between child self assessed HRQL and school nursing documentation was evaluated. Validity and reliability of the Finnish version of PedsQL™ 4.0 was good (Child Self Report α=0.91, Parent-Proxy Report α=0.88). Children reported lower HRQL scores at the emotional (mean 76/80) than the physical (mean 85/89) health domains and significantly lower scores at the age of 10 than 12 (dMean=4, p=<0.001). Agreement between child self and parent-proxy assessment was fragile (r=0,4, p=<0.001) but increased as the child grew from age 10 to 12 years. At health check-ups, school nurses documented frequently children’s physical health, such as growth (97%) and posture (98/99%) but seldom emotional issues, such as mood (2/7%). The PedsQLTM 4.0 is a valid instrument to assess HRQL in Finnish school children although future research is recommended. Children’s emotional wellbeing needs future attention. HRQL scores increase during ages between childhood and adolescence. Concordance between child self and parent-proxy assessed HRQL is low. School nursing documentation, related to child health check-ups, is not in line with child self assessed HRQL and emotional issues need more attention.

Kun ajanhenki vie

Kirjallisuusarvostelu

Tunneälytaitojen ja transformationaalisen johtamisen roolit kosmetiikkamyymälän johtamisessa

Tutkimuksen tavoitteena oli kuvata ja ymmärtää tunneälymallin osa-alueiden ja transformationaalisen johtamisosaamisen ilmenemistä kosmetiikkatoimialalla toimivan case-yrityksen päälliköiden käytännön esimiestyössä. Aihetta tarkasteltiin teoreettisen viitekehyksen kautta empiirisesti myymäläpäälliköille tehdyn kvalitatiivisen teemahaastattelun ja kvantitatiivisin menetelmin kerätyn johtamisen itsearvion vastausten sekä alaisten antamien arvioiden avulla. Tutkimuksesta nousi esille useita yhteneväisyyksiä ja ristiriitaisuuksia aikaisempiin tunneälyn ja transformationaalisen johtamisen tutkimuksiin. Lähes kaikkien muuttujien tilastollisesti erittäin merkitsevät ja korkeat korrelaatiot nousivat tutkimuksen tuloksista yllätykseksi. Tuloksina havaittiin, että päälliköillä oli hyvin kehittyneet tunneälytaidot interpersonaallisten tekijöiden ja yleisen hyvinvoinnin alueilla sekä karismaattisen ja transaktionaalisen passiivisen johtamisen alueilla. Päälliköiden heikoiten kehittyneet tunneälytaidot olivat paineensietokyvyn alueilla. Johtopäätöksenä voitiin havaita esimiesten luovan positiivista palveluilmastoa sosiaalisen vuorovaikutuksen ja merkitysten luomisen kautta ja siten johtaminen perustui vahvasti käytännönläheiseen realismiin ja korkeaan tunneälyyn.

Ammattisotilaiden kuormitusfysiologiset vasteet sotilaallisen harjoituksen aikana ja niiden yhteys kuntoindeksiin

Suomalaisten ammattisotilaiden kenttäkelpoisuus arvioidaan vuosittain suoritettavilla testeillä, jotka koostuvat fyysisen kunnon testeistä sekä palvelusammunnoista. Tällä hetkellä alin hyväksyttävä kenttäkelpoisuusluokka on kaksi (2.0). Viime vuosina taistelukentän kuva on kuitenkin muuttunut entistä vaativammaksi, joka vaatii sotilasjohtajilta yhä kovempaa fyysistä ja henkistä kuntoa. Suomessa ammattisotilaiden fyysistä kuormittumista sotilaallisen harjoituksen aikana ei ole juurikaan tutkittu, vaan tutkimukset ovat painottuneet varusmiesten ja reserviläisten tutkimukseen. Kuormitusfysiologisia muutoksia voidaan tutkia mittaamalla esimerkiksi hormonaalisia vasteita. Autonomisen hermoston muutoksia voidaan selvittää mittaamalla sykevälivaihtelua, joka on noninvasiivinen tutkimusmenetelmä. Tämän tutkimuksen tarkoituksena oli selvittää ammattisotilaiden kuormitusfysiologiset vasteet sotilaallisen harjoituksen aikana sekä miten ne ovat yhteydessä kuntoindeksiin. Koehenkilöinä oli yhdeksän (n=9) miespuolista ammattisotilasta, jotka toimivat sodanajan organisaation mukaisessa Karjalan Jääkäriprikaatin esikunta- ja viestipataljoonan keskeisissä johto-, päällikkö- ja asiantuntijatehtävissä. He osallistuivat mittauksiin sotilaallisen harjoituksen aikana, joka kesti viisitoista päivää. Ennen harjoitusta koehenkilöt suorittivat alkumittaukset, joilla selvitettiin heidän fyysisen kunnon lähtötaso sekä stressihormonitasot. Ennen harjoitusta koehenkilöt suorittivat myös liikunta- ja terveyskäyttäytymiskyselyn sekä henkisen kuormittumisen arviointikyselyn (POMS, Profile of Mood States). POMS kysely uusittiin samansisältöisenä harjoituksen viimeisen päivän aamulla. Hormonaalisia vasteita mitattiin alkumittauksen lisäksi harjoituksen 8. ja 15. päivinä. Harjoituksen aikana koehenkilöiltä kerättiin kolmena vuorokautena sykevälivaihtelutietoa, alkaen mittauspäivän aamuna ja päättyen seuraavaan aamuun. Sykevälivaihtelutiedostot analysoitiin käyttämällä hyvinvointianalyysiä. Tilastolliset analyysit tehtiin SPSS- ohjelmalla käyttäen toistettujen mittausten ANOVA:a. Vapaa- aikanaan 11 % koehenkilöistä ei harrastanut juuri mitään liikuntaa. Viikoittain yhtenä tai useampana päivänä rauhallista ja verkkaista liikuntaa harrasti 33 % ja 56 % harrasti yhdestä kolmeen kertaan viikossa ripeää ja reipasta liikuntaa. Viimeisen kolmen kuukauden aikana liikunnan määrä oli 56 %:lla vähentynyt. 67 % koehenkilöistä ilmoitti kärsivänsä selkävaivoista. Alkumittausten perusteella koehenkilöiden keskimääräinen kuntoindeksi oli 3.0, joka vastaa Cooperin juoksutestin perusteella noin 44 ml/kg/min. Sotilaallinen harjoitus ei ollut hengitys- ja verenkiertoelimistölle kuormittava. Kuormitusfysiologiset vasteet muodostuivat pääasiassa psyykkisten stressitekijöiden ja olosuhteiden yhteisvaikutuksesta. Harjoituksen aikana ei koehenkilöille muodostunut energiavajetta. Vapaan testosteronin määrä seerumissa laski koko harjoituksen ajan ja oli harjoituksen lopussa keskimäärin 17 % alkutilannetta alhaisemmalla tasolla. Lasku ei ollut kuitenkaan tilastollisesti merkittävä. Henkilökohtaiset erot olivat sen sijaan huomattavat. Henkilökohtaisia vapaan testosteronin vasteita selitti kuntoindeksi (r= 0.665, p= 0.051). Tämän tutkimuksen mukaan erottelevaksi fyysisen kunnon rajaksi muodostui kuntoindeksin taso 3.0, jonka omaavat henkilöt suoriutuivat kohtuuttomasti rasittumatta rauhanajan sotilaallisesta harjoituksesta. Unen määrällä oli merkittävä vaikutus elimistön kuormittumisen tasoon (r= 0.783, p= 0.013). Keskimääräinen vuorokautinen unen määrä oli 6h 20 min. Tämän tutkimuksen mukaan noin 5h 30 min yöuni on riittävä taso toimintakyvyn säilymisen kannalta sotilaallisen harjoituksen aikana. Kuormitusfysiologiset vasteet eivät vaikuttaneet merkittävästi koehenkilöiden mielialoihin. POMS- mieliala kyselyn perusteella koehenkilöt olivat harjoituksen jälkeen hieman ”kyllästyneempiä”, mutta ”paremmalla mielin” alkutilanteeseen verrattuna. Johtopäätöksenä voidaan todeta, että sotilaallinen harjoitus ei ole fyysisesti kuormittavaa. Kuormittumista syntyy kuitenkin johtuen muista tekijöistä ja ammattisotilaiden kuntoindeksin tulisi olla vähintään tasolla 3.0, jotta rauhanajan tehtävissä ei kohtuuttomasti kuormituta.

Glädje i vårdandets värld

The present study is made in the context of basic research within the field of caring science. The overall aim is to uncover and make joy visible as an idea in the world of caring. The core of caring has historically always been to alleviate suffering and to serve life and health in a spirit of love and mercy. This study has a comprehensive direction focusing on history of ideas and culminates in a pattern of ideas contenting joy in the world of caring. Knowledge formation is based on creating understanding, wholeness and meaning with regard to the knowledge related to a context. For that a hermeneutical approach is used throughout the study. In order to understand joy more deeply, the original idea, the essence and expression, the concept of 'joy' and the related concepts of 'glad' and 'light' are examined in etymological dictionaries and in Swedish, English and Latin dictionaries. To support the interpretation classical texts containing philosophers’ thoughts about joy are used. Joy as an idea glimpses forth and is presented in the form of seven-fold pattern of ideas. Through the meaning-nuances of synonyms a realization of joy could be discerned and anchored in the heart. The seven-fold pattern form the background and represent a guide for the hermeneutic reading of joy, as it appears in the stories about caring for the years 1900–1933. The historical sources consist of the trade magazine Svensk sjukskötersketidning, books containing stories about caring, archival materials and textbooks on nursing. The result culminates in the seven-fold pattern of ideas contenting what makes joy active as caring. The true heart's pure joy - love, joy is a proof of love. The ardent heart's deep joy - joy of living, joy inspires and generates strength. The bearing heart's radiant joy - generosity, joy is a gift to the other with the promise of help. The inviting heart's sparkling joy – communion, joy invites communion. The elated heart's exhilarated joy - integration, joy enables the human to forget his or her suffering and approach to what he or she wants to be. The atmospheric heart's solemn joy - dignifying, joy creates a mood and an atmosphere where people perceive themselves dignified. The peaceful heart's great joy - rescuing, a joy turns out when the human has received what may be requested of what is good, is eluded from what is evil and is contented with his or her living lot. It is hoped that this basic research will open up for a vision that can contribute to joys further attention in the world of caring and be articulated there.

Att tala om det osägbara : Nicolaus Cusanus cirkulära filosofi i verket De coniecturis med särskild hänsyn till Nelson Pikes tankar om unio mystica

In my dissertation called Speaking of the unsayable: The circular philosophy of Nicholas of Cusa in his work De coniecturis, I presuppose an internal (conceptual) relation between the personal experience of God of Nicholas of Cusa (1401-64) in 1438 and, on the other hand, his philosophy. I hence try to describe the precise character of this relation. Referring to the Norwegian scholars Egil Wyller and Viggo Rossvær, I assume that there is a circularity in Cusanus’ philosophy which appears as self-references (= a sentence refers to itself: A is explained by B and B is explained by A). Wyller finds three phases in the thought of Cusanus (1. De docta ignorantia I-III, 2. De coniecturis I-II, 3. all subsequent works). Rossvær finds it impossible to presuppose certain phases, as the philosophy of Cusanus continuously proceeds and remains open to new ideas. As Cusanus however treats his experience of God far more consciously in his second work De coniecturis than in De docta ignorantia, I find it possible to distinguish between the earlier Cusanus (De docta ignorantia including his earlier works) and the later Cusanus (De coniecturis, about 1444, as well as the following works). Cusanus creates a philosophy of language in outline expressed in De coniecturis, in which he presents two concepts of necessity, i.e. absolute necessity and logical, or reasonable, necessity. These are interrelated in the sense that the mind, or the self, logically affirms the absolute, or unsayable, necessity, which shows itself in the mind and which the mind affirms conjecturally. The endeavour conceptually to understand absolute necessity implies intuitive (or intellectual) contemplation, or vision (investigatio symbolica), in which the four mental unities (the absolute, the intellectual, the rational and the sensuous) work together according to the rules described in De coniecturis. In De coniecturis Cusanus obviously turns from a negative concept of the unsayable to a paradigmatic, which implies that he looks for principles of speaking of the unsayable and presents the idea of a divine language (divinaliter). However, he leaves this idea behind after De coniecturis, although he continues to create new concepts of the unsayable and incomprehensible. The intellectual language of absolute seeing is expressed in the subjunctive, i.e. conditionally. In order to describe the unsayable, Cusanus uses tautologies, the primary one of which is a concept of God, i.e. non aliud est non aliud quam non aliud (the non-other is non-other than the nonother). Wyller considers this the crucial point of the philosophy of Cusanus (De non aliud), described by the latter as the definition of definitions, i.e. the absolute definition. However, this definition is empty regarding its content. It demonstrates that God surpasses the coincidence of opposites (coincidentia oppositorum) and that he is “superunsayable” (superineffabilis), i.e. he is beyond what can be conceived or said. Nothing hence prevents us from speaking of him, provided that he is described as unsayable (= the paradigmatic concept of the unsayable). Here the mode of seeing is decisive. Cusanus in this context (and especially in his later literary production) uses modalities which concern possibility and necessity. His aim is to conduct any willing reader ahead on the way of life (philosophia mentalis). In De coniecturis II he describes the notion of human self-consciousness as the basis of spiritual mutuality in accordance with the humanistic tradition of his time. I mainly oppose the negatively determined concept of Christian mysticism presented by the German philosopher Kurt Flasch and prefer the presentation of Burkhard Mojsisch of the translogical and conjectural use of language in De coniecturis. In particular, I take account of the Scandinavian research, basically that of Johannes Sløk, Birgit H. Helander, Egil Wyller and Viggo Rossvær, who all consider the personal experience of God described by Cusanus a tacit precondition of his philosophy.

Social Solidarity and Fear of Crime - Community and Individual Approaches in Responses to Mass Violence after School Shootings

The aim of this study was to examine community and individual approaches in responses to mass violence after the school shooting incidents in Jokela (November 2007) and Kauhajoki (September 2008), Finland. In considering the community approach, responses to any shocking criminal event may have integrative, as well as disintegrative effects, within the neighborhood. The integration perspective argues that a heinous criminal event within one’s community is a matter of offence to collectively held feelings and beliefs, and increases perceived solidarity; whereas the disintegration perspective suggests that a criminal event weakens the social fabric of community life by increasing fear of crime and mistrust among locals. In considering the individual approach, socio-demographic factors, such as one’s gender, are typically significant indicators, which explain variation in fear of crime. Beyond this, people are not equally exposed to violent crime and therefore prior victimization and event related experiences may further explain why people differ in their sensitivity to risk from mass violence. Finally, factors related to subjective mental health, such as depressed mood, are also likely to moderate individual differences in responses to mass violence. This study is based on the correlational design of four independent cross-sectional postal surveys. The sampling frames (N=700) for the surveys were the Finnish speaking adult population aged 18–74-years. The first mail survey in Jokela (n=330) was conducted between May and June 2008, approximately six months from the shooting incident at the local high-school. The second Jokela survey (n=278) was conducted in May–June of 2009, 18 months removed from the incident. The first survey in Kauhajoki (n=319) was collected six months after the incident at the local University of Applied Sciences, March– April 2009, and the second (n=339) in March–April 2010, approximately 18 months after the event. Linear and ordinal regression and path analysis are used as methods of analyses. The school shootings in Jokela and Kauhajoki were extremely disturbing events, which deeply affected the communities involved. However, based on the results collected, community responses to mass violence between the two localities were different. An increase in social solidarity appears to apply in the case of the Jokela community, but not in the case of the Kauhajoki community. Thus a criminal event does not necessarily impact the wider community. Every empirical finding is most likely related to different contextual and event-specific factors. Beyond this, community responses to mass violence in Jokela also indicated that the incident was related to a more general sense of insecurity and was also associating with perceived community deterioration and further suggests that responses to mass violence may have both integrating and disintegrating effects. Moreover, community responses to mass violence should also be examined in relation to broader social anxieties and as a proxy for generalized insecurity. Community response is an emotive process and incident related feelings are perhaps projected onto other identifiable concerns. However, this may open the door for social errors and, despite integrative effects, this may also have negative consequences within the neighborhood. The individual approach suggests that women are more fearful than men when a threat refers to violent crime. Young women (aged 18–34) were the most worried age and gender group as concerns perception of threat from mass violence at schools compared to young men (aged 18–34), who were also the least worried age and gender group when compared to older men. It was also found that concerns about mass violence were stronger among respondents with the lowest level of monthly household income compared to financially better-off respondents. Perhaps more importantly, responses to mass violence were affected by the emotional proximity to the event; and worry about the recurrence of school shootings was stronger among respondents who either were a parent of a school-aged child, or knew a victim. Finally, results indicate that psychological wellbeing is an important individual level factor. Respondents who expressed depressed mood consistently expressed their concerns about mass violence and community deterioration. Systematic assessments of the impact of school shooting events on communities are therefore needed. This requires the consolidation of community and individual approaches. Comparative study designs would further benefit from international collaboration across disciplines. Extreme school violence has also become a national concern and deeper understanding of crime related anxieties in contemporary Finland also requires community-based surveys.

Asleep or not asleep? Evaluation of the Quality of Patients’ Sleep in Critical Care Nursing

Sleep is important for the recovery of a critically ill patient, as lack of sleep is known to influence negatively a person’s cardiovascular system, mood, orientation, and metabolic and immune function and thus, it may prolong patients’ intensive care unit (ICU) and hospital stay. Intubated and mechanically ventilated patients suffer from fragmented and light sleep. However, it is not known well how non-intubated patients sleep. The evaluation of the patients’ sleep may be compromised by their fatigue and still position with no indication if they are asleep or not. The purpose of this study was to evaluate ICU patients’ sleep evaluation methods, the quality of non-intubated patients’ sleep, and the sleep evaluations performed by ICU nurses. The aims were to develop recommendations of patients’ sleep evaluation for ICU nurses and to provide a description of the quality of non-intubated patients’ sleep. The literature review of ICU patients’ sleep evaluation methods was extended to the end of 2014. The evaluation of the quality of patients’ sleep was conducted with four data: A) the nurses’ narrative documentations of the quality of patients’ sleep (n=114), B) the nurses’ sleep evaluations (n=21) with a structured observation instrument C) the patients’ self-evaluations (n=114) with the Richards-Campbell Sleep Questionnaire, and D) polysomnographic evaluations of the quality of patients’ sleep (n=21). The correspondence of data A with data C (collected 4–8/2011), and data B with data D (collected 5–8/2009) were analysed. Content analysis was used for the nurses’ documentations and statistical analyses for all the other data. The quality of non-intubated patients’ sleep varied between individuals. In many patients, sleep was light, awakenings were frequent, and the amount of sleep was insufficient as compared to sleep in healthy people. However, some patients were able to sleep well. The patients evaluated the quality of their sleep on average neither high nor low. Sleep depth was evaluated to be the worst and the speed of falling asleep the best aspect of sleep, on a scale 0 (poor sleep) to 100 (good sleep). Nursing care was mostly performed while the patients were awake, and thus the disturbing effect was low. The instruments available for nurses to evaluate the quality of patients’ sleep were limited and measured mainly the quantity of sleep. Nurses’ structured observatory evaluations of the quality of patients’ sleep were correct for approximately two thirds of the cases, and only regarding total sleep time. Nurses’ narrative documentations of the patients’ sleep corresponded with patients’ self-evaluations in just over half of the cases. However, nurses documented several dimensions of sleep that are not included in the present sleep evaluation instruments. They could be classified according to the components of the nursing process: needs assessment, sleep assessment, intervention, and effect of intervention. Valid, more comprehensive sleep evaluation methods for nurses are needed to evaluate, document, improve and study patients’ quality of sleep.

Människans liv med sömnbesvär och hur människor med sömnbesvär upplever kognitiv beteendeterapi

Sleep disorders are a common health problem in western countries. Every third working age person suffers from sleep deprivation and that often leads to other health problems as well. One can end up in a vicious circle, which can further decrease mood and ability to function. The aim of this thesis is to illustrate how sleep deprivation affects the lives of working age population and to deepen our understanding of life with sleep deprivation. Study questions are: how does sleep deprivation affect a working age person’s life and what kind of experiences do people have about cognitive-behavioural therapy as a treatment to sleep disorders. Theoretical perspective is based on clinical nursing science theories and the humanist view of man, which sees human as an entity. The methodology used is phenomenological approach and data analysis is conducted by using Ricœur’s hermeneutic phenomenological interpretation method. The empirical part is divided into two different sections. The material of the study consists of interviews and surveys done by people who have experienced sleep deprivation or sleep disorders. Two interviewees talked about their lives with sleep disorders and there are 21 surveys conducted on people’s experiences on cognitive-behavioural therapy. The partakers in the two sections are different people. The results show that people with sleep disorders can end up in a vicious circle of sleep deprivation and in worst cases a sleep disorder can take charge of a person’s whole life. Sleep disorder can cause shame and fear of stigma. Nevertheless, someone suffering from a sleep disorder can find strength and solutions to control the difficult situation. This study proves that both nursing staff and other people have little information about difficulties in sleeping and awareness should be improved in clinical nursing. A health-care provider has an essential role in preventing someone ending up in a vicious circle of sleep deprivation and cognitive-behavioural therapy can contribute to good health. Reflection at the end of cognitive-behavioural sleep therapy course helps patients to continue their learning process. When someone is sleep deprived, it means that they have control over the situation, but when someone has a sleep disorder, that person does not have the strength to control the situation.