Sjuksköterskors erfarenheter av andliga och existentiella frågor i palliativ vård : En litteraturöversikt

Bakgrund: Andliga och existentiella frågor hamnar i allt större utsträckning hos sjukvårdspersonal. Det palliativa förhållningssättet betonar vikten av att ge en god omvårdnad vad gäller andliga och existentiella frågor. Sjuksköterskans roll är att genom goda relationer skapa en anpassad och balanserad omvårdnad för att öka välbefinnandet för patienten den sista tiden i livet. Syfte: Syftet med litteraturöversikten var att sammanställa hur andliga och existentiella frågor beskrivs i forskning utifrån sjuksköterskors erfarenheter av palliativ vård. Metod: En litteraturöversikt som sammanställer aktuell forskning inom det valda omvårdnadsområdet. Resultat: I resultatet framträdde att tid är det vanligaste hindret och utbildning är det som främjar givandet av andlig och existentiell omvårdnad. Att skapa relationer och kommunicera är viktiga aspekter inom vårdandets konst. Egenskaper som sjuksköterskan bör inneha för att underlätta givandet av andlig och existentiell omvårdnad är; en god självkännedom, empati, intuition och observationsförmåga. Slutsats: För att kunna ge en bättre andlig och existentiell omvårdnad behöver de yttre förutsättningarna ge tid för mötet mellan sjuksköterska och patient, vårdmiljön organiseras så detta möjliggörs, teamarbete tillämpas och utbildning ges.

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.

LEISURE CONNECTIONS AND HEALING FOLLOWING TRAUMA: CONSTRUCTIVIST AND EXISTENTIAL REFLECTIONS AND THEORIZING

Trauma can have lasting effects on health (CAMH, 2010; DSM-IV, 1994; Lazarus, 1966), negatively influencing meanings and experiences of leisure in relation to health (Griffin, 2002, 2005; Meister & Pedlar, 1996). This interpretive grounded theory explored understandings of leisure during Leisure Connections and how Leisure Connections provides a context for healing from trauma. Data included observations, interviews with six participants, and reflection cards. Nine themes emerged: responding to trauma in leisure, letting go of familiar coping patterns and opening to joy, being in the moment of small steps and simple things, changing understandings of self, reconnecting with the body, shifting to internal motivation, choosing, reconnecting with others in leisure, balancing life with leisure, and growth and connections. Leisure Connections supported participants to explore leisure and its benefits as issues arise, to understand and respond differently. Leisure Connections provides boundary situations critical for existential growth and opportunity to change coping patterns.

Spiritist Psychiatric Hospitals in Brazil: Integration of Conventional Psychiatric Treatment and Spiritual Complementary Therapy

In Brazil, during the XX century, dozens of Spiritist psychiatric hospitals emerged seeking to integrate conventional medical treatment with complementary spiritual therapy. This combined inpatient treatment is largely found in Brazil, where many psychiatric hospitals stem from the Spiritist movement. The present report describes the use of these spiritual practices, their operating structure, health professionals involved, modalities of care, and institutional difficulties in integrating spiritual practices with conventional treatment in six leading Brazilian Spiritist psychiatric hospitals. These hospitals combine conventional psychiatric treatment with voluntary-based spiritual approaches such as laying on of hands ("fluidotherapy"), lectures regarding spiritual and ethical issues, intercessory prayer, spirit release therapy ("disobsession") and "fraternal dialogue". The non-indoctrination and optional nature of these spiritual complementary therapies seem to increase acceptance among patients and their family members. In conclusion, the Spiritist psychiatric hospitals in Brazil have, for more than half a century, provided an integrative approach in the treatment of psychiatric disorders, associating conventional and spiritual treatments, more specifically Spiritist therapy. The lack of standardized treatment protocols and scientific studies remain a barrier to assessing the impact of this integrative approach on patients' mental health, quality of life, adherence, and perceived quality of treatment.

Beauty, Class and Discourse: Issues in Debate

In this text we proceed through a brief review of Naomi Lee`s (2009) article, highlighting her significant contributions to social and cultural psychology. In our dialogue with her text we inquire about some arguments and methodological procedures she presents. We raise some specific questions related to how the issue of beauty is framed, and we ponder on how a broadening of the scope to include history-of ideas, of relations-would bring some important elements to her approach. As Lee relates beauty and class, we examine the nuanced meanings of lack and deficiency in her analytical work. We also discuss her assumptions and position concerning discourse and dialogue which mark her ways of proceeding through the analysis of the interviews. We speculate that the depersonalized answer appointed in the interviewees` discourse can be related to a way of considering beauty as disembodied.

Health and safety issues in contemporary dental practice

Under current workplace health and safety legislation, the owners and managers of a dental practice have a legal responsibility to provide staff with a safe working environment. In this article, the emphasis will be on four common areas of risk: posture when seated, handling scalpel blades, flooring and lighting.

Antarctic tourists: A case study of their evaluation of Antarctic wildlife and environmental issues

Reports the results of surveys of Antarctic cruise ship passengers on the ‘Akademik Ioffe’ who undertook their Antarctic journey in January 2003. The prime purposes of the surveys were to determine the socio-economic profile of these travellers, evaluate the importance of Antarctic wildlife for their travel, their attitude to Antarctic wildlife conservation as well as environmental issues involving Antarctica, both prior to their tourist visit to Antarctica and following it. This paper reports on the socio-economic profile of respondents, their willingness to pay for their Antarctic trip, and their knowledge of Antarctica. The comparative importance of Antarctic wildlife as a factor motivating respondents to undertake their journey is assessed and the evaluation of travellers following their Antarctic visit is considered. The relative importance of different Antarctic wildlife species is taken into account as well as Antarctic attractions other than wildlife. The attitudes of respondents to several environmental issues involving Antarctica, (eg. the commercial use of its natural resources and global environmental change impacting on Antarctica) are canvassed and summarised. In conclusion, the relevance of the survey results for Antarctic conservation are discussed. Particular attention is given to the question of whether Antarctic tourism favours or threatens Antarctic nature conservation.

Glow worms as a tourist attraction in Springbrook National Park: Visitor attitudes and economic issues

nsect-based tourism mainly caters to a niche market, but its popularity has been growing in recent years. Despite its popularity this form of tourism has remained under-researched and in a sense its contribution to the tourism industry has gone mostly unnoticed. This paper reports the results of a study undertaken on one form of popular insect-based tourism, namely glow worms. The study was undertaken in Springbrook National Park (Natural Bridge section) southeast Queensland, which has one of the largest glow worm colonies in Australia that attracts thousands of visitors each year. A study of this form of tourism is important and useful for several reasons. It is important to understand this hitherto under-studied tourism activity to determine the type of visitors, their socio-economic attributes, economic benefits to the local economy, visitors’ knowledge of glow worms, education imparted, visitor satisfaction of glow worm viewing and visitor attitudes for the introduction of a user fee system to view glow worms. An understanding of these issues could not only help to better manage this valuable biological resource, but can be used to develop the industry to cater to a growing number of visitors. Tourism in glow worms can potentially be used not only to educate the public on the threats affecting glow worms and their colonies, but could also be used to conserve them. Lessons learnt from glow worms as an attraction to Springbrook National Park can be used to better manage and further develop other existing and new glow worm sites in Australia and elsewhere for tourism. Furthermore, it could provide some guidance for the management and development of other forms of current insect-based tourism activities (eg. butterflies) and develop new tourism ventures based on species such as stick insects and jewel beetles for which Australia is well known (Reader’s Digest, 1997)

Young children, adolescents and alcohol - Part I: Exploring knowledge and awareness of alcohol and related issues

This article explores young children's and adolescents' views pertaining to: knowledge and awareness of alcohol and alcohol related issues; social situations in which. alcohol use is present; orientation to alcohol risk; perceived and actual alcohol use; social image and reputation; and short and long term health beliefs in relation to alcohol. Forty focus groups were conducted with 240 primary school students (118 males and 122 females) and 24 focus groups were conducted with 192 high school students (90 males and 102 females); the total being 64 focus groups comprising 432 school students. Participants ages ranged from five years three months to 16 years 10 months. The videotaped discussions revealed that approximately 75% of the primary school-aged children and almost all of the high school students reported that they had tasted alcohol. Parents were primarily responsible for providing the alcohol. Virtually all participants recognised and were able to correctly name a selection of alcoholic and non-alcoholic beverages, and levels of knowledge and awareness of the health and safety aspects of alcohol were relatively mixed. Presentation of bottles and cans was reported as being important in attracting young persons. These data suggest there is an urgent need for research addressed to the development of prevention/intervention education curriculum materials for use with primary school-aged children.