Att möta patienter med psykisk ohälsa : Sjuksköterskans attityder och erfarenheter av att vårda patienter med psykisk ohälsa inom den somatiska vården

Bakgrund: Psykisk ohälsa ökar i hela världen, även i Sverige, främst hos den unga, kvinnliga befolkningen. Psykiska problem är ofta kopplade till somatisk ohälsa. Kvaliteten på den somatiska vården blir ofta sämre, mycket på grund av att många sjuksköterskor inte har tillräckligt med kunskap och erfarenhet inom psykiatriska omvårdnaden. Syfte: Föreliggande arbete avser att undersöka sjuksköterskors attityder och erfarenheter av patienter med psykisk ohälsa inom den somatiska vården. Metod: Litteraturöversikt av vetenskapliga artiklar. Litteratursökning i databaser med hjälp av lämpliga sökord. Artiklarnas kvalitet granskas sedan med hjälp av granskningsmallar. Resultat: Sammanlagt granskades 15 artiklar, varav 8 kvalitativa och 7 kvantitativa. Undersökningen visar att sjuksköterskor ofta har negativa erfarenheter av att vårda patienter med psykisk ohälsa. En förklaring kan vara bristande kunskap och färdigheter, vilket leder till rädsla, frustration och stress i mötet med dessa patienter. Även miljön nämns som som en stress- och orsaksfaktor till detta. Dessa faktorer leder till att sjuksköterskor till övervägande del har negativa attityder mot denna patientgrupp. Slutsats: Slutsatsen av undersökningen visar att de identifierade bristerna när det gäller kunskap och färdigheter bland annat leder till otrygghet vid vård av patienter med psykisk ohälsa inom den somatiska vården. Förbättring av detta tillstånd kan uppnås genom att höja sjuksköterskors kompetens, t.ex. genom att lägga större vikt på den psykiatriska omvårdnaden inom den praktiska utbildningen.

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.

A modest start, but a steady rise in research use : A longitudinal study of nurses during the first five years in professional life

Background: Newly graduated nurses are faced with a challenging work environment that may impede theirability to provide evidence-based practice. However, little is known about the trajectory of registered nurses’ use ofresearch during the first years of professional life. Thus, the aim of the current study was to prospectively examinethe extent of nurses’ use of research during the first five years after undergraduate education and specifically assesschanges over time.Method: Survey data from a prospective cohort of 1,501 Swedish newly graduated nurses within the nationalLANE study (Longitudinal Analyses of Nursing Education and Entry in Worklife) were used to investigate perceiveduse of research over the first five years as a nurse. The dependent variables consisted of three single itemsassessing instrumental, conceptual, and persuasive research use, where the nurses rated their use on a five-pointscale, from ‘never’ (1) to ‘on almost every shift’ (5). These data were collected annually and analyzed bothdescriptively and by longitudinal growth curve analysis.Results: Instrumental use of research was most frequently reported, closely followed by conceptual use, withpersuasive use occurring to a considerably lower extent. The development over time showed a substantial generalupward trend, which was most apparent for conceptual use, increasing from a mean of 2.6 at year one to 3.6 atyear five (unstandardized slope +0.25). However, the descriptive findings indicated that the increase started onlyafter the second year. Instrumental use had a year one mean of 2.8 and a year five mean of 3.5 (unstandardizedslope +0.19), and persuasive use showed a year one mean of 1.7 and a year five mean of 2.0 (unstandardized slope+0.09).Conclusion: There was a clear trend of increasing research use by nurses during their first five years of practice.The level of the initial ratings also indicated the level of research use in subsequent years. However, it took morethan two years of professional development before this increase ‘kicked in.’ These findings support previousresearch claiming that newly graduated nurses go through a ‘transition shock,’ reducing their ability to useresearch findings in clinical work.

Nurses' research utilization two years after graduation : a national survey ofassociated individual, organizational, and educational factors

Background. Nurses' research utilization (RU) as part of evidence-based practice is strongly emphasized in today's nursing education and clinical practice. The primary aim of RU is to provide high-quality nursing care to patients. Data on newly graduated nurses' RU are scarce, but a predominance of low use has been reported in recent studies. Factors associated with nurses' RU have previously been identified among individual and organizational/contextual factors, but there is a lack of knowledge about how these factors, including educational ones, interact with each other and with RU, particularly in nurses during the first years after graduation. The purpose of this study was therefore to identify factors that predict the probability for low RU among registered nurses two years after graduation. Methods. Data were collected as part of the LANE study (Longitudinal Analysis of Nursing Education), a Swedish national survey of nursing students and registered nurses. Data on nurses' instrumental, conceptual, and persuasive RU were collected two years after graduation (2007, n = 845), together with data on work contextual factors. Data on individual and educational factors were collected in the first year (2002) and last term of education (2004). Guided by an analytic schedule, bivariate analyses, followed by logistic regression modeling, were applied. Results. Of the variables associated with RU in the bivariate analyses, six were found to be significantly related to low RU in the final logistic regression model: work in the psychiatric setting, role ambiguity, sufficient staffing, low work challenge, being male, and low student activity. Conclusions. A number of factors associated with nurses' low extent of RU two years postgraduation were found, most of them potentially modifiable. These findings illustrate the multitude of factors related to low RU extent and take their interrelationships into account. This knowledge might serve as useful input in planning future studies aiming to improve nurses', specifically newly graduated nurses', RU.

Examining Visitor Attitudes and Motivations at a Space Science Centre

The H.R. MacMillan Space Centre is a multi-faceted organization whose mission is to educate, inspire and evoke a sense of wonder about the universe, our planet and space exploration. As a popular, Vancouver science centre, it faces the same range of challenges and issues as other major attractions: how does the Space Centre maintain a healthy public attendance in an increasingly competitive market where visitors continue to be presented with an increasingly rich range of choices for their leisure spending and entertainment dollars?This front-end study investigated visitor attitudes, thoughts and preconceptions on the topic of space and astronomy. It also examined visitors’ motivations for coming to a space science centre. Useful insights were obtained which will be applied to improve future programme content and exhibit development.

Contemporary Approaches to Translation in the Classroom : A study of students' Attitudes and Strategies

The purpose of this study is to explore the strategies and attitudes of students towards translation in the context of language learning. The informants come from two different classes at an Upper Secondary vocational program. The study was born from the backdrop of discussions among some English teachers representing different theories on translation and language learning, meeting students endeavoring in language learning beyond the confinement of the classroom and personal experiences of translation in language learning. The curriculum and course plan for English at the vocational program emphasize two things of particular interest to our study; integration of the program outcomes and vocational language into the English course - so called meshed learning – and student awareness of their own learning processes. A background is presented of different contrasting methods in translation and language learning that is relevant to our discussion. However, focus is given to contemporary research on reforms within the Comparative Theory, as expressed in Translation in Language and Teaching (TILT), Contrastive Analysis and “The Third Space”. The results of the students’ reflections are presented as attempts to translate two different texts; one lyric and one technical vocational text. The results show a pragmatic attitude among the students toward tools like dictionaries or Google Translate, but also a critical awareness about their use and limits. They appear to prefer the use of first language to the target language when discussing the correct translation as they sought accuracy over meaning. Translation for them was a natural and problem-solving event worth a rightful place in language teaching.

Condoms and Healthcare professionals : Risk-behavior and attitudes towards condom use

Alarming S.T.I’s percentages and low condom use motivated this research. Healthcare professional’s risk-behavior and attitudes towards risk-behavior were reviewed. Three hypotheses, aimed to test whether healthcare professionals working with S.T.I’s should have a different attitude, knowledge and behavior to condom use compared to healthcare professionals that did not work with S.T.I’s. Ninety-five participants working at a hospital in middle-Sweden answered a questionnaire, based on the Swedish UNGKAB09 research. Mann-Whitney analyses showed no significant difference between the two groups on knowledge, attitude and behavior. A high percentage of steady relationships, high homogeneity between groups as well the same attitudes and intentions could have been a reliability problem. The collected data was however interesting as a base for further research

Vård i livets slut av personer med demens. Personal och anhörigas upplevelse av given vård : En metasyntes

Palliativt förhållningssätt kännetecknas av helhetssyn av människan och uppnås genom stöttning av individen att leva med värdighet och största möjliga välbefinnande till livets slut oavsett diagnos eller ålder. Demens är en sjukdom som är svårt handikappande för den som drabbas och för de anhöriga är sjukdomen förödande. Den palliativa vården av personer med demens är inte optimerad. Studier visar att det dels beror på demenssjukdomen som är svår att vårda och dels för att stöd till de personer som vårdar sina anhöriga och det sociala kommunala nätverket har brister. Syfte: Att analysera upplevelsen av given vård i livets slutskede hos personer med demensdiagnos ur personalens och anhörigas perspektiv. Metod: Metasyntes utförd med Howell Major och Savin-Badins analysmodell, Qualitative Research Synthesis. Resultat: Kunskap och personcentrering var de två begrepp som blev produkten av syntesen. Begreppen fungerar som motsatser, om det finns kunskap och personcentrering så finns en bra upplevelse av given vård hos personal och anhöriga och om det brister i kunskap och personcentrering blir upplevelsen sämre. Diskussion: Kunskap om demens bland personal har i syntesen visats vara en indikator för god vård vid livets slut. Utbildning i demenssjukdom bör ske kontinuerligt och på olika nivåer beroende på vilken personalkategori som utbildas. Konklusion: Palliativ vård och demens måste få utrymme i utbildningarna av all personal, från undersköterska till specialistläkare.

Health care providers' perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia : a systematic literature review of qualitative and quantitative data.

BACKGROUND: Unsafe abortions are a serious public health problem and a major human rights issue. In low-income countries, where restrictive abortion laws are common, safe abortion care is not always available to women in need. Health care providers have an important role in the provision of abortion services. However, the shortage of health care providers in low-income countries is critical and exacerbated by the unwillingness of some health care providers to provide abortion services. The aim of this study was to identify, summarise and synthesise available research addressing health care providers' perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia. METHODS: A systematic literature search of three databases was conducted in November 2014, as well as a manual search of reference lists. The selection criteria included quantitative and qualitative research studies written in English, regardless of the year of publication, exploring health care providers' perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia. The quality of all articles that met the inclusion criteria was assessed. The studies were critically appraised, and thematic analysis was used to synthesise the data. RESULTS: Thirty-six studies, published during 1977 and 2014, including data from 15 different countries, met the inclusion criteria. Nine key themes were identified as influencing the health care providers' attitudes towards induced abortions: 1) human rights, 2) gender, 3) religion, 4) access, 5) unpreparedness, 6) quality of life, 7) ambivalence 8) quality of care and 9) stigma and victimisation. CONCLUSIONS: Health care providers in sub-Saharan Africa and Southeast Asia have moral-, social- and gender-based reservations about induced abortion. These reservations influence attitudes towards induced abortions and subsequently affect the relationship between the health care provider and the pregnant woman who wishes to have an abortion. A values clarification exercise among abortion care providers is needed.

Factors associated with evidence-based practice among registered nurses in Sweden : a national cross-sectional study

Background: Evidence-based practice (EBP) is emphasized to increase the quality of care and patient safety. EBP is often described as a process consisting of distinct activities including, formulating questions, searching for information, compiling the appraised information, implementing evidence, and evaluating the resulting practice. To increase registered nurses' (RNs') practice of EBP, variables associated with such activities need to be explored. The aim of the study was to examine individual and organizational factors associated with EBP activities among RNs 2 years post graduation. Methods: A cross-sectional design based on a national sample of RNs was used. Data were collected in 2007 from a cohort of RNs, included in the Swedish Longitudinal Analyses of Nursing Education/Employment study. The sample consisted of 1256 RNs (response rate 76%). Of these 987 RNs worked in healthcare at the time of the data collection. Data was self-reported and collected through annual postal surveys. EBP activities were measured using six single items along with instruments measuring individual and work-related variables. Data were analyzed using logistic regression models. Results: Associated factors were identified for all six EBP activities. Capability beliefs regarding EBP was a significant factor for all six activities (OR = 2.6 - 7.3). Working in the care of older people was associated with a high extent of practicing four activities (OR = 1.7 - 2.2). Supportive leadership and high collective efficacy were associated with practicing three activities (OR = 1.4 - 2.0). Conclusions: To be successful in enhancing EBP among newly graduated RNs, strategies need to incorporate both individually and organizationally directed factors.

Attitudes towards the minority variety Caló in the south of Spain : a sociolinguistic study

Caló is a variety spoken by the Spanish Calé (i.e. the Roma). It belongs to a group of languages referred to as “Para-Romani”, characterized by Romani vocabulary, but largely non-Romani morphology, phonology and syntax, in the case of Caló deriving from Spanish. According to previous research carried out – with focus on the vocabulary and the grammar of this variety – Caló is on its way to extinction. However, there is an expressed interest in reintroducing a form called “Romanó-Caló”. Attitudes play an important role in minority language maintenance as well as in order for a revitalization project to be successful. The aim of this study is to measure the attitudes that both Calé and non-Calé have towards Caló and Caló speakers, a type of study never carried out in the past. The methods applied are both direct and indirect. In total, 231 informants listened to different recordings of voices acting as either a “Spanish speaking person” or a “Caló speaking person”, a technique referred to as ‘matched guise’, answering questions related to the voices on attitude scales. Furthermore, 182 of the informants rated their agreement or disagreement to positive and negative items towards Caló and its speakers on a Likert scale. The results of the analysis indicate that the attitudes differ towards Caló and Caló speakers, depending on the informant’s (a) ethnicity (b) contact with Caló as well as with Caló speakers, and (c) gender. It is those who – in their own opinion – belong to the ethnic group Calé, as well as those who claim that they have some contact with the variety and its speakers, who show positive attitudes in both parts of the study. The women also show more positive attitudes than the men. It is also possible to note positive attitudes towards the variety and its speakers among the subjects with a high level of knowledge of Caló words, as well as among those with the highest willingness to use Caló. These observations suggest that a revitalization project of the variety Caló has a clear chance of being successful.

Corporal Punishment : A study about attitudes and opinions to corporal punishment and the connection to children’s rights in South Africa and Sweden

Corporal punishment is a worldwide problem. The purpose withthis thesis is to promote a constructive discussion about the problem andconnect this to children’s rights. This gives the possibility to start adiscussion about suggestions and measures to reduce the problem. Thetheory is that corporal punishment is used as a disciplinary method tochange behavior. Children’s rights is regulated by conventions and nationallaws. The method is to conduct an analysis with interpretations andcommentaries of the research materials from South Africa and Sweden.The conclusion is that those who are positive to corporal punishment thinksit is an efficient working method, and it is about children’s safety. Thosewho are negative have experienced that alternative methods works. Asuggestion is to involve children in the work with children’s rights andeducate them in human and children’s rights with focus on obligations andresponsibility.

The effects of attitudes and personality traits on mode choice

We hypothesise that differences in people's attitudes and personality traits lead them to attribute varying importance to environmental considerations, safety, comfort, convenience and flexibility. Differences in personality traits call be revealed not only in the individuals' choice of transport, but also in other actions of their everyday lives-such as how much they recycle, whether they take precautions or avoid dangerous pursuits. Conditioning on a set of exogenous individual characteristics, we use indicators of attitudes and personality traits to form latent variables for inclusion in an, otherwise standard, discrete mode choice model. With a sample of Swedish commuters, we find that both attitudes towards flexibility and comfort, as well as being pro-environmentally inclined, influence the individual's choice of mode. Although modal time and cost still are important, it follows that there are other ways, apart from economic incentives, to attract individuals to the, from society's perspective, desirable public modes of transport. Our results should provide useful information to policy-makers and transportation planners developing sustainable transportation systems.

Swedish Primary Teachers' Attitudes towards Integrating Gaming in the EFL Classroom

A current topic in Swedish schools is the use of computer games and gaming. One reason is because computers are becoming more and more integrated into the schools, and the technology plays a large role in the everyday lives of the pupils. Since teachers should integrate pupils’ interests in the formal teaching, it is of interest to know what attitudes teachers have towards gaming. Therefore the aim of this empirical study is to gain an insight into the attitudes Swedish primary teachers have towards online and offline computer games in the EFL classroom. An additional aim is to investigate to what extent teachers use games. Five interviews were conducted with teachers in different Swedish schools in a small to medium-sized municipality. After the interviews were transcribed, the results were analyzed and discussed in relation to relevant research and the sociocultural theory. The results show that teachers are positive towards games and gaming, mostly because gaming often contains interaction with others and learning from peers is a main component in sociocultural theory. However, only one out of the five participants had at some point used games. The conclusion is that teachers are unsure about how to use games in their teaching and that training and courses in this area would be valuable. More research is needed within this area, and it would be of value to investigate what suggested courses would contain and also to investigate exactly how games can be used in teaching.

Managerial leadership for research use in nursing and allied health care professions : a narrative synthesis protocol

BACKGROUND: Nurses and allied health care professionals (physiotherapists, occupational therapists, speech and language pathologists, dietitians) form more than half of the clinical health care workforce and play a central role in health service delivery. There is a potential to improve the quality of health care if these professionals routinely use research evidence to guide their clinical practice. However, the use of research evidence remains unpredictable and inconsistent. Leadership is consistently described in implementation research as critical to enhancing research use by health care professionals. However, this important literature has not yet been synthesized and there is a lack of clarity on what constitutes effective leadership for research use, or what kinds of intervention effectively develop leadership for the purpose of enabling and enhancing research use in clinical practice. We propose to synthesize the evidence on leadership behaviours amongst front line and senior managers that are associated with research evidence by nurses and allied health care professionals, and then determine the effectiveness of interventions that promote these behaviours.Methods/design: Using an integrated knowledge translation approach that supports a partnership between researchers and knowledge users throughout the research process, we will follow principles of knowledge synthesis using a systematic method to synthesize different types of evidence involving: searching the literature, study selection, data extraction and quality assessment, and analysis. A narrative synthesis will be conducted to explore relationships within and across studies and meta-analysis will be performed if sufficient homogeneity exists across studies employing experimental randomized control trial designs. DISCUSSION: With the engagement of knowledge users in leadership and practice, we will synthesize the research from a broad range of disciplines to understand the key elements of leadership that supports and enables research use by health care practitioners, and how to develop leadership for the purpose of enhancing research use in clinical practice.