Existential issues in surgical care : Nurses’ experiences and attitudes in caring for patients with cancer

The overall aim of this thesis was to explore surgical nurses’ experiences of being confronted with patients’ existential issues when caring for patients with cancer, and to examine whether an educational intervention may support nurses in addressing existential needs when caring for patients with cancer. Previously recorded discussions from supervision sessions with eight healthcare professionals were analysed (I), written descriptions of critical incidents were collected from 10 nurses, and interviews with open questions were conducted (II). An educational intervention on existential issues was pilot tested and is presented in Studies III and IV. The intervention was the basis of a pilot study with the purpose of testing whether the whole design of the educational intervention, including measurements instruments, is appropriate. In Study III and IV interviews with 11 nurses were conducted and 42 nurses were included in the quantitative measurements of four questionnaires, which were distributed and collected. Data was analysed using qualitative secondary analysis (I), hermeneutical analysis (II), and mixed methods using qualitative content analysis and statistical analyses (III-IV). Results in all studies show that existential issues are part of caring at surgical wards. However, although the nurses were aware of them, they found it difficult to acknowledge these issues owing to for example insecurity (I-III), a strict medical focus (II) and/or lacking strategies (I-III) for communicating on these issues. Modest results from the pilot study are reported and suggest beneficial influences of a support in communication on existential issues (III). The results indicate that the educational intervention may enhance nurses’ understanding for the patient’s situation (IV), help them deal with own insecurity and powerlessness in communication (III), and increase the value of caring for severely ill and dying patients (III) in addition to reducing work-related stress (IV). An outcome of all the studies in this thesis was that surgical nurses consider it crucial to have time and opportunity to reflect on caring situations together with colleagues. In addition, descriptions in Studies III and IV show the value of relating reflection to a theory or philosophy in order for attitudes to be brought to awareness and for new strategies to be developed.

Familjemedlem till person med psykossjukdom : bemötande och utanförskap i psykiatrisk vård

This thesis focused on the situation of family members of persons with psychotic illness, particular on their experience of the approach of the healthcare professionals and of their feelings of alienation regarding the professional care of their family member. A further aim was to explore how siblings who have participated in a support group for siblings experienced their situation. A questionnaire was developed that enabled the aims of this thesis to be investigated (I). Seventy family members from various parts of Sweden participated, and data were collected via the questionnaire developed in study I (II-III). Thirteen siblings who previously had participated in a support group participated in follow-up focus groups interviews (IV). The questionnaire developed was shown to be reliable and valid in these studies (I). In many cases, the participants had experienced an approach from professionals that indicated that they did not experience openness, confirmation and cooperation, and that they felt powerless and socially isolated in relation to the care. There was also found to be a certain degree of association between how the participants experienced the approach and whether they felt alienation (II). The majority of the participants considered openness, confirmation, and cooperation to be important aspects of professional’s approach. The result also identified a low level of agreement between the participants’ experience and what they considered to be significant in the professional’s approach (III). The findings revealed the complexity of being a sibling of an individual with psychotic illness. Participating in a support group for siblings can be of importance in gaining knowledge and minimizing feelings of being alone (IV). Although the psychiatric care services in Sweden have been aware of the importance of cooperating with family members, the results indicated that there is a need for further research in this area.

English-medium instruction in Sweden : Perspectives and practices in two upper secondary schools

This thesis presents English-medium instruction (EMI) in the Swedish context, focusing on perspectives and practices in two schools. The research question is as follows: How and why is EMI offered, chosen, and practiced in the Swedish upper secondary school today? The aim is to explore the status of the educational option, the reasons for offering EMI to stakeholders, the stakeholders’ beliefs about and goals of EMI, and the implementation of EMI in the classroom. A survey of all upper secondary schools in Sweden was conducted to ascertain the spread of content teaching through a foreign language. The educational context was studied from an ecological perspective using methods based in linguistic ethnography. Language alternation, academic language, and language hierarchy were all considered. Interviews were analysed for content; and classroom language use was analysed for language choice and function. The concepts of affordance and scaffolding together with translanguaging were key. The de facto policies of the micro contexts of the schools were examined in light of the declared national policy of the macro context of Sweden. The results indicate that the option in Swedish schools has not increased, and also tends to only be EMI—not Content and Language Integrated Learning (CLIL) or instruction through other languages. EMI is offered for prestige, an international profile, marketing potential and personal interest. EMI students are academically motivated and confident, and see the option as “fun”. 100% EMI in the lessons is not the goal or the practice. Translanguaging is abundant, but how language alternation is perceived as an affordance or not differs in the two schools. One focuses on how the languages are used while the other focuses on how much each language is used. In conclusion, the analysis suggests that a development of definitions and practices of EMI in Sweden is needed, especially in relation to language policy and language hierarchy.

Learning by Reading : A literature study on the use of authentic texts in the EFL upper elementary classroom

The English language is widely used throughout the world and has become a core subject in many countries, especially for students in the upper elementary classroom. While textbooks have been the preferred EFL teaching method for a long time, this belief has seemingly changed within the last few years. Therefore, this study looks at what prior research says about the use of authentic texts in the EFL upper elementary classroom with an aim to answer research questions on how teachers can work with authentic texts, what the potential benefits of using authentic texts are and what teachers and students say about the use of authentic texts in the EFL classroom. While this thesis is written from a Swedish perspective, it is recognized that many countries teach EFL. Therefore, international results have also been taken into consideration and seven previous research studies have been analyzed in order to gain a better understanding of the use of authentic texts in the EFL classroom. Results indicate that the use of authentic texts is beneficial in teaching EFL. However, many teachers are still reluctant to use these, mainly because of time constraints and the belief that such texts are too difficult for their students. Since these findings are mainly focused on areas outside of Sweden, additional research is needed before conclusions can be drawn on the use of authentic texts in the Swedish upper elementary EFL classroom.

Authentic Texts in English Language Teaching : An empirical study on the use of and attitudes towards authentic texts in the Swedish EFL upper elementary classroom

International assessments indicate that Swedish students achieve high results in reading, writing and understanding English. However, this does not mean that the students display oral proficiency, despite an emphasis on functional and communicative language skills in the current English Syllabus. While a previous literature study by this researcher has shown that authentic texts are a way to increase these skills, most of the results shown are from an international viewpoint. Thus an empirical study was conducted within Sweden with the aim to examine the use of authentic texts in the Swedish EFL upper elementary classroom. Twelve teachers have answered a questionnaire on how they use authentic texts in their language teaching, as well as their opinions about these as a teaching tool. Additionally, 37 students have answered a questionnaire on their attitudes about authentic texts. Results indicate that all of the teachers surveyed see authentic texts as an effective way to increase students’ communicative competence and English language skills; however, only a few use them with any frequency in language teaching. Furthermore, this seems to affect the students’ attitudes, since many say that they read authentic texts in their free time, but prefer to learn English out of a textbook at school. These findings are based on a small area of Sweden. Therefore, further research is needed to learn if these opinions hold true for the entire country or vary dependent upon region or other factors not taken into consideration in this study.