Sjuksköterskans stöd till barn med smärta : Barnets copingstrategierFöräldrars samverkan

Syftet med denna litteraturstudie var att ta reda på hur sjuksköterskan kunde stödja barn vid smärta, vilka copingstrategier barn använde sig av när de upplevde smärta och hur sjuksköterskan genom samverkan med föräldrarna kunde stödja barnet vid smärta. Metoden som användes för att göra denna studie var deskriptiv systematisk litteraturstudie. Litteratur har sökts i databaserna Elin@Dalarna och Blackwell Synergi. Sökorden som användes var children, pain, coping, care, parent, pain management, nursing, pediatric, dental care, qualitative och quality of life. Materialet i litteraturstudien har begränsats till 22 artiklar som har granskats efter mallar. Resultatet av studien visade att sjuksköterskan bör ha god kontakt med barnet för att kunna stödja det i sin smärtupplevelse. Sjuksköterskan använde oftast farmakologiska medel för att lindra barnets smärta, men även icke-farmakologiska metoder för att stödja barnet vid smärta. Olika metoder användes, som till exempel att distrahera barnet. De olika copingstrategier barnen använde sig av vid smärta var att leka, kramas, måla, blunda, tänka på något annat och avslappning. När barnet kände att de kunde hantera sin smärta så upplevde de högre livskvalitet. Föräldrarnas närvaro påverkade barnets smärtupplevelse på ett positivt sätt. Föräldrarna upplevde att de inte hade fått tillräckligt med information om sina barns smärtupplevelse. Föräldrarnas samverkan var en naturlig del i smärtbehandlingen.

Att leva nära den palliativa vården, ur de närståendes perspektiv – en litteraturöversikt

Bakgrund: Idag lever många nära en person som drabbats av en livshotande sjukdom. Många som insjuknar har behov av den palliativa vården. Den palliativa vården syftar till att främja livskvalitet och lindra lidande, både för patienten och för de närstående. När en person i familjen blir sjuk är det naturligt för de flesta människor att ta rollen som vårdare och familjen anses ha en stor betydelse i vården av den sjuke. Att erhålla information samt stöd är viktiga förutsättningar för att de närstående ska kunna känna delaktighet i vården. Sjuksköterskan har till uppgift att lindra lidande, främja hälsa samt ge stöd och information. Syfte: Att belysa de närståendes erfarenheter av den palliativa vården. Design: En litteraturöversikt. Metod: 14 vetenskapliga artiklar som blivit publicerade under de senaste fem åren, har lästs flertalet gånger och därefter analyserats utifrån en innehållsanalys, för att finna gemensamma kategorier som beskriver de närståendes erfarenheter/ upplevelser. Resultat: Närheten till döden var något som väckte starka känslor, och situationen beskrevs vara fysiskt, psykiskt och emotionellt påfrestande. Resultatet visar att de närstående tog ett stort ansvar i vården av den sjuke, detta resulterade i ett ökat behov av stöd, framförallt från familj och vänner. En god relation till vårdpersonalen ökade förutsättningarna till en god vård. Trots den svåra situationen kunde meningsfullhet upplevas. Slutsats: Sjukdomen medförde att livssituationen förändrades och en ökad ansvarskänsla uppstod hos den närstående. Stöd från familj och vänner, samt vårdpersonal hade stor betydelse. Kunskap hos vårdpersonalen värderades högt och det var viktigt att den sjuke skulle få dö en värdig och fridfull död.

Health and quality of care from older peoples' and formal caregivers' perspective

Aim: The overall aim of this thesis was to gain a deeper understanding of older people's view of health and care while dependent on community care. Furthermore to describe and compare formal caregivers' perceptions of quality of care, working conditions, competence, general health, and factors associated with quality of care from the caregivers' perspective. Method: Qualitative interviews were conducted with 19 older people in community care who were asked to describe what health and ill health((I), good and bad care meant for them (II). Data were analyzed using content analysis (I) and a phenomenological analysis (II). The formal caregivers; 70 nursing assistants (NAs) 163 enrolled nurses (ENs) and 198 registered nurses (RNs), answered a questionnaire consisting of five instruments: quality of care from the patient's perspective modified to formal caregivers, creative climate questionnaire, stress of conscience, health index, sense of coherence and items on education and competence (III). Statistical analyses were performed containing descriptive statistics, and comparisons between the occupational groups were made using Kruskal-Wallis ANOVA, Mann-Whitney U-test and Pearson's Chi-square test (III). Pearson's  product moment correlation analysis and multiple regression analysis were performed studying the associations between organizational climate, stress of conscience, competence, general health and sense of coherence with quality of care (IV). Results: The older people's health and well-being were related to their own ability to adapt to and compensate for their disabilities and was described as negative and positive poles of autonomy vs. dependence, togetherness vs. being an onlooker, security vs. insecurity and tranquility vs. disturbance (I).  The meaning of good care (II) was that the formal caregivers respected the older people as unique individuals, having the opportunity to live their lives as usual and receiving a safe and secure care. Good care could be experienced when the formal caregivers had adequate knowledge and competence in caring for older people, adequate time and continuity in the care organization (II). Formal caregivers reported higher perceived quality of care in the dimensions medical-technical competence and physical-technical conditions than in identity-oriented approach and socio-cultural atmosphere (III). In the organizational climate three of the dimensions were close to the value of a creative climate and in seven near a stagnant climate. The formal caregivers reported low rate of stress of conscience. The RNs reported to a higher degree than the NAs/ENs a need to gain more knowledge, but the NAs and the ENs more often received training during working hours. The RNs reported lower emotional well-being than the NAs/ENs (III). The formal caregivers' occupation, organizational climate and stress of conscience were associated with perceived quality of care (IV). Implications: The formal caregivers should have an awareness of the importance of kindness and respect, supporting the older people to retain control over their lives. The nursing managers should employ highly competent and adequate numbers of skilled formal caregivers, organize formal caregivers having round the clock continuity. Improvements of organizational climate and stress of conscience are of importance for good quality of care.

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.