Sjuksköterskors erfarenheter och upplevelser av att vårda patienter med självskadebeteende : en kvalitativ intervjustudie

Bakgrund: Självskadebeteende är ett sedan länge förekommande fenomen som kan vara framträdande hos patienter med en oförmåga att reglera affekter. Det innebär ett lidande för patienterna och det bidrar till en känslomässig påverkan hos sjuksköterskorna. För att skapa en gynnsam omvårdnadsrelation behövs resurser, kunskap, kompetens och stöd för sjuksköterskorna i omvårdnaden. Syfte: Beskriva sjuksköterskans erfarenheter och upplevelser av att vårda patienter med självskadebeteende. Metod: Data samlades in från sex sjuksköterskor genom kvalitativa semi-strukturerade intervjuer med stöd av en intervjuguide. Materialet har analyserats med kvalitativ innehållsanalys. Resultat: Det framkom fyra kategorier "Att självskada", "Behov av kompetens", "Ge omvårdnad" och "Känslomässig påverkan". Sjuksköterskorna lyfte svårigheter i omvårdnaden, behovet av kompetens och den känslomässiga påverkan de drabbades av i mötet med patienter med självskadebeteende. Slutsats: Självskadebeteende skapar många olika känslor hos sjuksköterskorna, både positiva och negativa. Sjuksköterskorna upplevde att patienter med självskadebeteende var en svår, men intressant grupp att arbeta med. Tidsbrist, stress och upprepade självskadehandlingar var påfrestande och de känslor som uppkom hos sjuksköterskorna var inte alltid lätta för dem att hantera. Sjuksköterskorna poängterade vikten av att fånga upp patienter i tid men beskrev även svårigheterna i att kunna göra det. Sjuksköterskorna efterfrågade utökat stöd, kunskap och bättre resurser för att känna sig trygga i sin yrkesroll samt för att kunna erbjuda patienter med självskadebeteende en god och säker omvårdnad.

Omvårdnad av patienter som vårdas enligt lagen om psykiatrisk tvångsvård (LPT) inom psykiatrisk slutenvård: Sjuksköterskors upplevelser och erfarenheter : En kvalitativ intervjustudie

Bakgrund: All sjukvård i Sverige styrs av Hälso-och sjukvårdslagen [HSL]. Under vissa omständigheter kan denna lag behövas kompletteras med Lagen om psykiatrisk tvångsvård [LPT]. Dessa personer vårdas inom psykiatrisk slutenvård. Omvårdnadens syfte är att patienten samtycker till vården och tvångsvården kan över gå till frivillig vård. Dessa personers problematik är dock ofta komplex och omvårdnaden upplevs innebära många svårigheter för sjuksköterskorna. Syfte: Att beskriva sjuksköterskors erfarenheter och upplevelse av omvårdnad i samband med LPT-vård inom sluten psykiatrisk vård. Metod: Empirisk kvalitativ studie med deskriptiv design. Studien baseras på sju semistrukturerade intervjuer med sjuksköterskor. Dessa analyserades med manifest innehållsanalys. Resultat: Resultatet visade att en förutsättning för att uppnå målet med tvångsvården genom omvårdnad var att skapa en allians med patienten. Kommunikation som innefattade individuellt anpassad information var en nyckelfaktor till alliansskapande. Omvårdnadsarbetet innefattade samverkan och sjuksköterskorna upplevde ett behov av kompetensutveckling. Slutsats: Sjuksköterskor upplever att omvårdnad enligt LPT är en utmaning och sammankopplat med flertalet svårigheter. Erhålls kompetens, tid för reflektion och trygghet i arbetsgruppen ses dock inte omvårdnaden som en omöjlighet utan kan upplevas som positivt för både den som vårdar och för den som vårdas.

Sjuksköterskans upplevelse av att ge personcentrerad vård till personer med demenssjukdom : En litteraturstudie

Background: Dementia impairs cognitive functions, such as memory and speech, changing a person’s life forever. Providing person-centred care to these persons intend to retain their identities, dignity and autonomy. Such care demands time, devotion and good knowledge of the caring nurse. Dementia is expected to increase in the future and therefore nurses will have to face new challenges. Aim: To describe nurses’ experience of providing person-centred care for people with dementia. Method: A literature review of 15 articles, published between 2009-2016, that have been read and analysed through content-analysis. Results: Nurses experience a positive change in their attitudes, when providing person-centred care to people with dementia, as they gained better understanding of their patients’ dignity and integrity. Education, training and support from management were seen as key factors for providing up-to-date care. Time was viewed as a hindrance for person-centred care, and often led to nurses prioritizing other routines. Two common outcomes of person-centred care were increased satisfaction as well as emotional burnout. Conclusion: Since dementia is increasing and nurses find person-centred care time-consuming, there is a risk of such care becoming poor. To prevent this nurses need good leadership and education.

Paradigms in health care and its relationship to the nursing theories: an analytical test

DANTAS, Rodrigo Assis Neves; NÓBREGA, Walkíria Gomes da; MORAIS FILHO, Luiz Alves; MACÊDO, Eurides Araújo Bezerra de ; FONSECA , Patrícia de Cássia Bezerra; ENDERS, Bertha Cruz; MENEZES, Rejane Maria Paiva de; TORRES , Gilson de Vasconcelos. Paradigms in health care and its relationship to the nursing theories: an analytical test . Revista de Enfermagem UFPE on line. v.4,n.2, p.16-24.abr/jun. 2010. Disponível em < http://www.ufpe.br/revistaenfermagem/index.php/revista>.

(Des)igualdades de Género nas Organizações de Trabalho: o caso de uma autarquia local

Em Portugal, cerca de duas centenas de organizações estão empenhadas a criar e implementar Planos para a igualdade de homens e mulheres. Entre elas estão empresas públicas e privadas, autarquias, associações empresariais, organizações do setor terciário, associações de desenvolvimento, universidades, ministérios e outros departamentos governativos. A pesquisa que aqui se expõe inscreveu-se num projeto mais amplo de diagnóstico em realização na Câmara Municipal da Lousã, que se encontra a promover um Plano Municipal para a Igualdade. Nesse âmbito mostrou-se necessário fazer um diagnóstico interno à organização com uma perspetiva de género, quer em termos de desigualdades de género na composição e situação dos seus efetivos quer de forma a conhecer as representações das pessoas que trabalham na autarquia, em torno do fenómeno da (des)igualdade de mulheres e homens. Para a sua realização foi feita análise estatística a dados fornecidos pela organização, e aplicou-se um inquérito por questionário ao pessoal ao serviço da autarquia. Concluiu-se que estamos na presença do fenómeno da desigualdade em função do sexo na estrutura da organização traduzida pela segregação ocupacional e segregação vertical, sendo os homens que apresentam os maiores níveis de antiguidade, que justificarão, de certa forma, as disparidades salariais existentes. Confirmamos uma dualidade entre o ideal de mulher como mãe e dona-de-casa e o de mulher como pessoa independente, especialmente quando são evocadas as consequências da sua atividade profissional sobre os/as filhos/as e a vida familiar. O papel de cuidar surge assim como o obstáculo a conceções menos tradicionalistas e individualizadoras da identidade feminina que nos remete para uma mudança na atribuição do lugar social de homens e mulheres dentro e fora da família. Sobressai a valorização e enfatização da maternidade e do cuidado das crianças na identidade feminina; ao passo que aos homens se atribui uma maior valorização da atividade profissional. Esta constatação comprova a ambivalência e dicotomia de valores e atitudes entre uma fuga à convencional polarização entre papéis “masculinos” e “femininos” rígida e estereotipadamente definidos. / In Portugal, about two hundred organizations are committed to create and implement plans for men and women’s equality. These include public and private companies, local authorities, business associations, third sector organizations, development associations, universities, ministries and other governmental departments. The research exposed here is part of a broader diagnostic project taking placa in the City Hall, of Lousã which is promoting a Municipal Plan for Equality. In this context it was necessary to make an internal diagnosis to the organization from a perspective of gender, either in terms of gender inequalities in the composition and status of their workers or in order to know the workers representations around the phenomenon of women and men’s equality. To make it passible the organization provided statistical data which was analysed and subsequentaly a questionnaire was applied to the municipality staff. We concluded that there is the phenomenon of gender inequality in the structure of the organization namely occupational/professional segregation and vertical segregation, - men having the highest levels of seniority, which may justify in some way the existing wage gap. The study confirms a duality between the ideal of woman as a mother and housewife and the woman as an independent person, especially when the consequences suggested are related to their professional activity on their children and life family. The role of caring emerges as the obstacle to less traditionalist conceptions of female identity and individualization, which leads us to talk about a change of the social position of men and women within and outside the family. It points out the valuation and emphasizing of motherhood and care in female identity, whereas men are given a greater appreciation of the professional activity. This conclusion confirms the ambivalence and dichotomy of values and attitudes between escape from the conventional polarization between rigid and stereotypically defined roles of "male" and "female".

Resiliência, Coping e Autocompaixão em Cuidadores Formais da Rede Nacional de Cuidados Continuados Integrados

Introdução: Na literatura internacional e nacional verifica-se a inexistência de estudos sobre os correlatos psicológicos de cuidadores formais, como a resiliência e o coping. Apesar de se reconhecer a importância de uma prestação de cuidados mais compassivos e humanizados, mais uma vez, não existem estudos nesta área. Este facto estende-se aos cuidadores formais que trabalham com pessoas em situação de dependência, na Rede Nacional de Cuidados Continuados Integrados. Assim, foram nossos objetivos: caraterizar os cuidadores formais de algumas Unidades de Cuidados Continuados (UCC) da RNCCI em variáveis sociodemográficas e profissionais; analisar os seus níveis de resiliência, coping e autocompaixão; verificar se existem associações significativas entre estas variáveis e com as variáveis sociodemográficas e profissionais. Metodologia: 78 cuidadores formais (sexo feminino, n = 76; 97,4%), com uma média de idades de 35,45 anos (DP = 9,0) forneceram o seu consentimento informado para preencherem um questionário sociodemográfico e profissional, a Escala de Avaliação Global da Resiliência, o Brief COPE e a Self Compassion Scale (SELFCS). Resultados: Os cuidadores revelaram um nível médio de resiliência (total). A dimensão de coping com média mais elevada foi o Coping ativo e a com média mais baixa foi o Uso de substâncias. Na SELFCS a dimensão com média mais elevada foi o Calor/compreensão e a com média mais baixa foi o Isolamento. No geral, a pontuação total de resiliência correlacionou-se de forma positiva com as dimensões positivas da autocompaixão (SELFCS) e de forma negativa com as dimensões negativas desta escala. As dimensões mais positivas de coping correlacionaram-se de forma positiva com as dimensões positivas de autocompaixão e as mais negativas de coping com as dimensões negativas de autocompaixão. Quanto maior a idade dos cuidadores menor o nível de Suporte Emocional e maior o nível de Religião e Mindfulness. Mais horas de trabalho associaram-se a menor resiliência e a maior nível de Suporte Emocional Discussão: Este estudo revelou, ainda que numa amostra reduzida, que os cuidadores formais das UCC parecem revelar níveis equilibrados em correlatos psicológicos importantes quando se “cuida” de outra pessoa. Porém, as UCC devem preocupar-se em fomentar, junto dos cuidadores, níveis mais elevados de resiliência, estratégias mais positivas de coping e a compaixão auto e hétero dirigida, para assegurar um “cuidar” mais pleno quer para os profissionais, quer para aqueles que são cuidados. / Introduction: In the international and national literature, we verified the inexistence of studies about psychological correlates of formal caregivers, such as resilience and coping. Although the importance of more humanized and compassive care is recognized, again, there are no studies in this area. This is also verified regarding formal caregivers that work with people in a dependence situation, as in the National Network of Continuous Care. Our aims were to characterize the formal caregivers from some units of the National Network of Continuous Care in sociodemographic and professional variables; analyze these professionals levels of resilience, coping and self-compassion; verify if there are significant associations between these variables and with the sociodemographic and professional variables. Methodology: 78 formal caregivers (female, n = 76; 97,4%), with an mean age of 35,45 years (SD = 9,0) provided their informed consent to fill in a professional and sociodemographic questionnaire, the Global Resiliency Evaluation Scale, the Brief COPE and the Self Compassion Scale (SELFCS). Results: The caregivers showed a medium level of resilience. The coping dimension with the highest mean was Active coping and the dimension with the lowest mean was Substance Use. Regarding SELFCS the dimension with the highest mean was Warmth, contrasting with Isolation, the dimension with the lowest mean. Overall, the total score of resilience was positively correlated with self-compassion positive dimensions (SELFCS) and negatively correlated with the negative dimensions of this scale. The most positive dimensions of coping were positively correlated with the positive dimensions of self-compassion and the most negative dimensions of coping were correlated with the negative dimensions of self-compassion. Older caregivers showed lower use of Emotional support and higher level of Religion and Mindfulness use. More daily hours of work were associated with less resilience and higher Emotional Support. Discussion: This study revealed, although in a small sample, that Continuous Care Units (CCU) formal caregivers seem to have balanced levels of psychological correlates that are important while caring for others. However, the CCU should promote, in the caregivers higher levels of resilience, coping and self-compassion, to ensure a better care, simultaneously the professionals and patients.

I Must Do the Post - Using Poetry for Raising Dementia Awareness

This paper reviews the use of a poem written by a care assistant as part of a dementia awareness course. the author of the poem went on to use the poem to help staff within the care home gain an insight and to promote reflection and discussion about caring for the person living with dementia as part of a training programme. an evaluation of its use was a also undertaken and staff reported that this poem was thought provoking, insightful and had helped them to reflect on how they work with people living with dementia.

Shining a Light on the Dark Side: How the Global Financial Crisis Exposed the Dark Side of Leadership

The global financial crisis has had innumerate outcomes around the globe. Whilst most of these are generally perceived to be negative, there are outcomes which could be considered positive for society. One such outcome is the spotlight that the financial crisis has shone on corruption within organisations and in particular, the role that destructive leaders play in the promotion of negative behaviours within organisations. This interest in identifying so-called ‘dark-side’ traits in leaders is a positive step both academically and practically. Academically, there is a limited research examining individuals with ‘dark-traits’ within organisations (Mahmut, Homewood & Stevenson, 2008). Practically, most leader derailment can be attributed to ‘dark-side’ traits and leaders with such traits are implicated in a host of issues for organisations including poor staff morale and satisfaction, bullying, poor levels of productivity, high staff turnover, unethical behaviour and even white collar crime (e.g. Boddy,2010; 2011; Lesha & Lesha, 2012; O’Boyle, Forsyth, Banks & McDaniel, 2012; Sanecka, 2013). This paper focuses on one of the ‘dark-side’ traits; psychopathy. Psychopathy is a personality disorder characterised by guiltlessness, incapacity to experience love, impulsivity, shallow emotions, superficial charm and an inability to learn from experience (Cleckley, 1941, 1982). Research has found that individuals with high levels of psychopathy can be found working within organisations and experiencing some degree of career success (e.g. Babiak, Neumann & Hare, 2010; Board & Fritzon, 2005; Boddy, 2010; Lilienfeld, Latzman, Watts, Smith & Dutton, 2014). These individuals are theoretically thought to be attracted to careers which offer power, status and monetary rewards. In particular, the finance industry has been suggested as an ideal work place for the organisational psychopath. Some authors go as far as attribute organisational psychopaths a key role in the financial crisis (Boddy, 2011). However, little research has been conducted to explore whether levels of psychopathy in employees differ across industries and what careers might be most attractive to individuals with high levels of psychopathy. This paper presents the results of a large scale survey of 265 alumni of universities in the Central England region of the UK. The survey was conducted to assess the link between levels of three factors of psychopathy (Egotism, Callousness and Antisocialism) with occupation as defined by Holland’s RIASEC model. Participants completed Brinkley, Diamond, Magaletta & Heigel’s (2008) revision of Levenson’s Self-Report Psychopathy Scale and responded to questions regarding their current occupation. Logistic regression analyses were conducted to assess whether levels of Egotism, Callousness and Antisocialism were predictive of occupation. The results showed that when compared to individuals who occupy job roles within the Social sector of Holland’s model, individuals with higher levels of psychopathy were more likely to be employed within Realistic, Investigative, Enterprising and Conventional roles. When comparing Social and Realistic roles, more Egotistical individuals were likely to be employed within Realistic roles. When comparing those employed in Social roles to Investigative, Enterprising and Conventional roles, individuals with higher levels of Antisocialism were more likely to be employed within the latter three occupations than within Social roles. This suggests that individuals with psychopathy do gravitate towards certain career paths. Social roles where job incumbents are required to be caring and interact with others to a large extent appear to be unattractive to individuals with high levels of psychopathy. Social roles are also associated with lower monetary rewards and are generally less prestigious (Henley, 2001). These individuals instead seek out occupations where there are higher levels of risk, power and reward. Roles in the Realistic category include those which include high levels of risk e.g. fighter pilot, fireman etc., (Cohen, Meir, Segal & Amar, 2003). Investigative careers hold the highest level of prestige and ranking. Enterprising roles include management positions where power is wielded over subordinates and sales roles, where customers can be manipulated (ACT, 2009). Conventional roles include those within the finance industry, which include some of the most financially lucrative positive available (Babiak & Hare, 2006). The above suggests that individuals with higher levels of psychopathy may be seeking to satisfy their self-centred natures by selecting careers which provide them with high levels of reward in one way or another. Alternatively, these individuals may select roles where their traits can be accepted. The importance of Antisocialism in predicting occupation may be testament to the importance of finding a career which ‘fits’ such traits. Antisocialism is generally associated with negative outcomes in the workplace (Ettner, MacLean & French, 2010). Therefore, finding environments tolerant of antisocial tendencies may be a priority for individuals with high levels of these traits. The results suggest that Enterprising, Investigative and Conventional work environments may be tolerant of Antisocialism in employees and Realistic environments tolerant of Egotism. Academically, the results show that there is value in studying ‘dark-side’ characteristics in organisations. Individuals with higher levels of psychopathic traits, do not appear to randomly enter employment. Instead, they appear to gravitate to careers which meet their needs and/or tolerate their traits. It is important to further explore what industries and positions are particularly attractive to individuals with higher levels of psychopathy and what makes them attractive to these individuals. Such knowledge is important for practitioners to be able to advise organisations as to the likely level of risk they face of employing organisational psychopaths and to enable organisations which are particularly attractive to highly psychopathic employees to design selection systems which detect undesirable traits in candidates. Furthermore, organisations can examine their culture to assess whether traits such as antisocialism are tolerated (or even rewarded) and what the implications of this are.

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.

Providing Palliative Care for the Child with Cancer: The Experience of GPs

Background Childhood cancers are rare and general practitioners (GPs) have limited experience in caring for these children and even less in providing their palliative care. Most families prefer that their child is cared for at home in the palliative phase of their illness, with professional support from those known to them (Chambers and Oakhill 1995, Vickers and Carlisle 2000, Craft and Killen 2007). A community based qualitative study examined the experiences of ten GPs following their involvement in the care of a child with cancer receiving palliative care within the family home. Methods Data collection was through 1:1 in-depth interviews and facilitated case discussion supported by field notes and grounded theory analysis (chronological comparative data analysis identifying generated themes). Social worlds theory was used as a framework to aid examination, and facilitate critical understanding, of the experiences of the GPs. Findings This presentation focuses on five of the findings relating to the experiences of the GP; the impact of minimal contact; lack of knowledge and experience, uncertain role, out of hours service provision and the emotional toll. Findings highlighted that GPs often have to re-establish their role at the child’s transition to palliative care. Factors hindering the GP in this process include a deficit of specialist knowledge and experience of paediatric palliative care and lack of role clarity. Conclusions/points of interest Strategies for enhancing the role of the Macmillan team in supporting GPs have been identified by this study, such as enhanced collaborative working. Findings have also provided further confirmation of the substantial variation in out of hours medical palliative care provision; with evidence that some GPs work beyond their remit in providing informal out of hours care. This presentation details the findings of one aspect (the experiences of GPs) of a wider study that explored the experiences of 54 community based health professionals (GPs, community nurses and allied health professionals) who had been involved in caring for a dying with cancer receiving palliative care at home (Neilson 2009).

Undertaking Sensitive Interviews: a Researcher’s Experience of Interviewing Bereaved Parents and Family GPs

The presentation describes the researcher’s experience of undertaking sensitive interviews. Background The interviews form part of a current study that is examining bereaved parents’ experience of caring for their child at home as well as the experience of their GP. This study builds on earlier work that found general practitioners (GPs) were at times uncertain of their role in paediatric palliative care and questioned whether their involvement had been beneficial to the child and family. The rarity of childhood cancer deaths makes it difficult for GPs to develop or maintain palliative care knowledge and skills yet the GP is perceived as the gatekeeper for care within the community. Presentation aim To describe the process of both the preparation for, and undertaking of, sensitive interviews. Study methodology The methodology incorporates tape-recorded semi-structured interviews, thematic framework analysis and Q methodology (QM). QM will be used to capture the experiences of GPs who have cared for a child with cancer receiving palliative care as well the perspectives of care experienced by the families. The semi-structured interview sample comprises 10 families (parents/guardians) whose child has been treated at a regional childhood cancer centre and their GPs. A further 40-60 GPs will be involved in the QM. Findings The preparation for these interviews will be discussed and compared to the supportive bereavement visits undertaken within the researcher’s role as a paediatric Macmillan nurse. The experience of undertaking the interviews will be exemplified with findings from the initial and the current, study. Papers’ contribution The researcher’s experience of preparing for and undertaking sensitive interviews may prove beneficial to other researchers.

Myths and Realities of Inter-professional Working

Introduction: Childhood cancers are rare and community based health care professionals have limited experience in caring for these children and often even less experience in providing their palliative care. It is well recognised that the provision of palliative care falls beyond the remit of any one profession, thus inter professional working is the standard model. This qualitative study aims to examine the experiences of the range of health care professionals involved in providing palliative care at home for children with cancer, focusing on how knowledge is exchanged; the level of communication and support both interprofessionally and at the community/specialist interface. It also aims to examine interprofessional collaboration in palliative care; identifying healthcare professional's perceptions of problems involved, interprofessional boundaries, specific areas of the organisation or provision of care that could be enhanced through changes in practice, support issues and the educational needs of health professionals. Methods The study involves three types of data collection; in-depth interviews, facilitated case discussion (FCD) and field notes from up to 20 cases (a "case" refers to the provision of palliative care to one child). Cases are selected from children who were treated at one regional childhood caner centre. For each case the community based health care professionals (for example the GP, community nurse or health visitor) involved in the care of the child at home are invited to participate in a one-to-one tape recorded in-depth interview followed by a group discussion in the form of a FCD. Field notes are completed following each interview. Data analysis follows a grounded theory approach. The term "social worlds theory" (SWT) his used to define a type of social organisation with no fixed or formal boundaries (such as membership boundaries), for example the range of health professionals that work together to provide palliative care. The boundaries of SW's are determined by the interaction and communication between recognised organisations, such as community nursing teams and general practitioners. SWT examines encounters between different professional groups and can be used to extend knowledge in both the organisation (for example general practice) and the content of what is being provisioned (for example, palliative care). The use of SWT in the analysis of the data is through examining the ethos of the different professions and the associated individual approaches to palliative care, exploring how this determines their roles in the provision of palliative care. Results 10 cases have so far been completed: 47 1:1 interviews (with a range of between 2-7 health care professionals being involved in each case): ( 9 x GP, 19 x CCN, 4 x DN, 3 x HV, 1 x HV assistant 7 x paediatric palliative care nurses, 1 x home support worker, 1 x OT, 1 x physiotherapist, 1 x community paediatrician) and 5 x FCD. The range of participants in the FCDs reflected that of the individual interview sampler. Data obtained to date gives clear insight into the personal experience of the individual health care professional in providing palliative care. Two themes emerging from the data will be focused upon: the continuity of care provision throughout treatment and palliation and the emotional burden experiences by the health care professional. Conclusions SWT can provide a useful framework in examining the social worlds of a disparate group of health care professionals working together for the first and maybe, the only time. A wide variation in the continuity of care provision has been found not only between professions, but also within professions. The emotional burden is evident across the professions.

Pathologies of Patriarchy: Death, Suffering, Care and Coping in the Gendered Gaps of HIV/AIDS Interventions in Nigeria

Thesis (Ph.D.)--University of Washington, 2016-08

From Screening to Synthesis: Using NVivo to Enhance Transparency in Qualitative Evidence Synthesis

Aims and objectives The aim of this qualitative evidence synthesis was to explore the experiences and perceptions of health care staff caring for people with dementia in the acute setting. This paper focuses on the methodological process of conducting framework synthesis using NVivo for each stage of the review: screening, data extraction, synthesis and critical appraisal. Background Qualitative evidence synthesis brings together many research findings in a meaningful way that can be used to guide practice and policy development. For this purpose, synthesis must be conducted in a comprehensive and rigorous way. There has been previous discussion on how using NVivo can assist in enhancing and illustrate the rigorous processes involved. Design Qualitative Framework Synthesis. Methods Twelve documents, or research reports, based on nine studies, were included for synthesis. Conclusion The benefits of using NVivo are outlined in terms of facilitating teams of researchers to systematically and rigorously synthesise findings. NVivo functions were used to conduct a sensitivity analysis. Some valuable lessons were learned and these are presented to assist and guide researchers who wish to use similar methods in future.

Challenges Facing Long Term Foster Carers: Exploration of the Nature of Psychoanalytic Parent/Carer Support

This research study investigates the role and impact of psychoanalytically-informed short-term parent work with long-term foster carers of looked-after children, in support of the foster placement. The study reflects on the data gathered from four child assessments and five foster families seen by a psychoanalytic child psychotherapist for four sessions each. It draws on psychoanalytic ideas from a range of theoretical traditions, exploring such concepts as trauma, defences, compulsion to repeat, psychological-mindedness, ‘container/contained’ (Bion) and ‘holding environment’ (Winnicott). One distinctive contribution of this research is what it adds to our already existing understanding of the defences (or responses) aroused in the carer when faced with the intense and distressing affect associated with the child’s early trauma; and the impact of this legacy of trauma on the child, on the carer and on the wider Social Services system. Applying Grounded Theory and psychoanalytically-informed clinical case study methodology to the research material, the study breaks down the data analysis into seven stages of coding, from the initial reading of the data to the eventual development of two key hypotheses. One of the predominant themes that emerged from the analysis was the carer’s capacity to remain focused on the child’s emotional needs and how this in turn was linked to the direction of the therapist’s focus. The successive analyses of the data culminated in the hypothesis that the more the therapist focused on the carer and the carer’s emotional states in the course of the parent work, the more the carer was enabled to focus on the child’s emotional needs. As the system of categories emerged according to the themes exemplified in the sessions, a particular focus of analysis became the concept of psychologicalmindedness, considered under several sub-categories: displaying insightful comments; awareness of the child’s bodily states; awareness of the child’s affect; the carer’s ability to recognize the child’s defences; and the carer’s ability to make links between the child’s current difficulties and the child’s past experiences. Through this analysis it became apparent that degree of psychological-mindedness was closely linked to the individual carer’s capacity to metabolize the child’s distressed and distressing communication. This in turn led to a deeper exploration of the situations that were particularly challenging for the carers: i.e., instances when the child was compelled to repeat past traumatic emotional states and as a result was communicating intense distress. This exploration eventually generated the second hypothesis: that in reaction to the child’s distress, the response of each carer could be plotted somewhere along a spectrum, from either distancing themselves from the child’s emotional state to seeking excessive closeness with the child (merging). The next stage of the analysis developed four new categories of carer responses to the distressed child: identification and distancing from the child; identification and merging with the child; the category that describes the carer’s psychologicalmindedness as being ‘impaired’; and ‘good enough’ caring. This then led to an exploration of the carer’s own defences at these most challenging times. This research demonstrates clearly that even within the short space of four sessions of weekly psychoanalytic parent work, it is possible to achieve significant improvement in a carer’s capacity to bear the child’s compulsion to repeat early traumas, and to help the carers become more emotionally available to provide the child with effective psychological parenting at such difficult and challenging times. Key words: looked-after children; long-term foster carers; psychoanalytic short-term parent work; trauma; compulsion to repeat; psychological-mindedness; empathy; defences; psychoanalytically-informed clinical case study research methodology; Grounded Theory research methodology.