Nurses’ perceptions of climate and environmental issues : a qualitative study

Aim: The aim of this study was to explore nurses' perceptions of climate and environmental issues and examine how nurses perceive their role in contributing to the process of sustainable development.  Background: Climate change and its implications for human health represent an increasingly important issue for the healthcare sector. According to the International Council of Nurses Code of Ethics, nurses have a responsibility to be involved and support climate change mitigation and adaptation to protect human health.  Design: This is a descriptive, explorative qualitative study.  Methods: Nurses (n=18) were recruited from hospitals, primary care and emergency medical services; eight participated in semi-structured, in-depth individual interviews and 10 participated in two focus groups. Data were collected from April-October 2013 in Sweden; interviews were transcribed verbatim and analysed using content analysis.  Results: Two main themes were identified from the interviews: (i) an incongruence between climate and environmental issues and nurses' daily work; and (ii) public health work is regarded as a health co-benefit of climate change mitigation. While being green is not the primary task in a lifesaving, hectic and economically challenging context, nurses' perceived their profession as entailing responsibility, opportunities and a sense of individual commitment to influence the environment in a positive direction.  Conclusions: This study argues there is a need for increased awareness of issues and methods that are crucial for the healthcare sector to respond to climate change. Efforts to develop interventions should explore how nurses should be able to contribute to the healthcare sector's preparedness for and contributions to sustainable development.

Med rena händer i kampen mot VRI : Sjuksköterskors följsamhet till riktlinjer om handhygien: främjande och hindrande faktorer En litteraturöversikt

Bakgrund: Uppkomsten av vårdrelaterade infektioner (VRI) är ett globalt problem. Den vanligaste smittvägen är via personalens händer. Bra handhygien är väsentligt för att minska VRI. Med bättre följsamhet till handhygien kan uppkomsten av VRI minskas, därför har forskning om följsamhet till handhygien och faktorer som inverkar, stort betydelse. Syfte: Syftet var att sammanställa och beskriva aktuell forskning om sjuksköterskors följsamhet till handhygien och vilka faktorer främjar respektive hindrar följsamheten till handhygien. Metod: En litteraturöversikt som baserades på artiklar publicerade de senaste fem åren, från länder som följer Världshälsoorganisationens (WHO) handhygieniska riktlinjer. Sexton artiklar valdes efter kvalitetsgranskning för analys och beskrivning. Artiklarna bearbetades med innehållsanalys. Resultat: Sjuksköterskors följsamhet till handhygien var låg. Följande främjande faktorer identifierades: handhygien efter patientkontakt, materialtillgång, förebilder, utbildning, verbala och visuella påminnelser, positiva individuella attityder, kvinnlig könstillhörighet, yrkesgrupp, specialitet, patientens skydd, arbetskultur och samhällets inställning till handhygien. Följande hindrande faktorer identifierades: hög arbetsbelastning, bristande utbildning, kunskapsbrist, individuella attityder, hudpåverkan, materialtillgång, arbetskultur och samhällets inställning till handhygien, manlig könstillhörighet, yrkesgrupp, specialitet. Slutsats: Enligt resultat rekommenderas: samspelet med kollegor och patienter, stöd av teamarbete ledare, förebilder, materialtillgång, utbildning, påminnelser, intervention med tillgång till information, stöd, resurser och möjligheter för regelbunden kunskapsuppföljning, motivera till handhygien före patientkontakt, involvera patienter.

"Att peka med hela handen" : En studie om omsorgspersonals upplevelser av makt och kommunikation.

In a report of the National Board of health and welfare they statethat the chief's role in the health care profession, plays a major role in, among other things, their psychosocial work environment and that communication is carrying for the prerequisite to achieve this. In this paper a qualitative study has been made of how protective services workers feel that their work environment is affected by the power situation in relation to the head. This data has been analyzed based on theories of power, communication and sense of context (SOC). The results show that informants feel that the manager's way of communicating is important partly for sense of context (SOC) of their work, but also that it is dependent on communication for power visible or not.

BEMÖTA BARNENS BEHOV : En kvalitativ studie av personalens upplevelser av yrkesroll och arbetsuppgifter på hem för vård eller boende för ensamkommande barn

The present study explores how members of staff at HVB for unaccompanied minors experience their work tasks, their roles as care givers, and what they mean it takes to meet the needs of the children. The data consists of six semi-structured interviews conducted at three different HVB. The interviews were analysed using reports made by the National Board of Health and Welfare (Socialstyrelsen) and the health and Social Care Inspectorate (IVO), and theories about resilience from mental illness. Furthermore, the current paper draws on previous research on the needs of unaccompanied minors and on international professionals’ roles and work tasks. The results show that the staff’s main task is to meet some of the needs of the children as their need of security, support, stability and sense of belonging. Time, knowledge, personal suitability and formal training were emphasized as important characteristics in order for them to adequately respond to the children’s needs.

Biståndshandläggaren och samvetsstressen : En kvalitativ intervjustudie

Syftet med studien var att utforska socialarbetares upplevelse av arbetsrelaterad samvetsstress. Vi ville identifiera vad samvetsstress kan vara för yrkesgruppen socialarbetare vars arbetsuppgift innefattar myndighetsutövning och vad i arbetet som orsakar samvetsstress. Sex stycken kvalitativa intervjuer genomfördes med socialarbetare vars yrke innefattar myndighetsutövning. Resultatet visar att samtliga intervjupersoner upplever samvetsstress när de beskriver sig ha svårt att hantera sitt dåliga samvete och att detta leder till negativa psykiska och fysiska stressymptom. Intervjupersonerna beskriver dock upplevelsen av samvetsstress i olika grad vilka kategoriserades: ständig närvaro av samvetsstress, närvaro av samvetsstress i vissa situationer samt medveten bortträngning av samvetsstress. Resultatet visar vidare att samvetsstress kan skapas av de krav och förväntningar som organisationen, brukare och anhöriga samt socialarbetaren själv har om de upplevs som övermäktiga och motstridiga. Vår studie indikerar på ett behov av vidare forskning om samvetsstress hos socialarbetare.

Barnmorskors erfarenheter av preventivmedelsrådgivning på ungdomsmottagning : - En intervjustudie

Bakgrund: Barnmorskans arbetsfält omfattar idag sexuell-, reproduktiv- och perinatal hälsa och det centrala i yrkesutövningen är att främja hälsa. Barnmorskan ska ha kunskaper om, kunna ge information och undervisa om sexualitet och samlevnad utifrån ett genus- och livscykelperspektiv. Uppdraget på ungdomsmottagning är att arbeta med sexualitet och hälsa samt att förebygga oönskade graviditeter och STI. Syfte: Syftet var att beskriva barnmorskors erfarenheter av preventivmedelsrådgivning på ungdomsmottagning. Metod: Individuella intervjuer genomfordes med nio barnmorskor på ungdomsmottagningar. Vid intervjutillfället användes en frågeguide och semistrukturerade frågor ställdes. Som analysmetod användes kvalitativ innehållsanalys. Resultat: Fyra kategorier och 15 subkategorier identifierades. Kategorierna var enligt följande: Erfarenheten och kunskapens betydelse, Det kliniska arbetssättet, Modererande faktorer och Utmaningar. Slutsats: Barnmorskor uppgav god kunskap och goda erfarenheter av ungdomar och preventivmedelsrådgivning på ungdomsmottagning men menade att det är ett dynamiskt arbete som bidrar till ständig utveckling. Vid möten med preventivmedelssökande ungdomar på ungdomsmottagning fanns önskan att mötet skulle ske på individnivå. Erfarenheter av modererande faktorer för barnmorskan, utmaningar för preventivmedelsrådgivningen och följsamheten fanns vilket innebar att preventivmedelsrådgivning för ungdomar på ungdomsmottagning är komplext. Klinisk tillämpbarhet: Studiens resultat skulle kunna innebära ökad förståelse för arbetet på ungdomsmottagning och skapa underlag för att möta utmaningarna som barnmorskorna möter i det dagliga arbetet.

How initial vocational education and training (IVET) teachers in Sweden perceive their prospects of being able to prepare upper secondary school pupils for a future occupation

Vocational teachers in Swedish upper secondary schools are a heterogeneous category of teachers, connected to different types of trade. These teachers represent a broad set of trade skills varying in content and character. In their teacher role, they continue to wear the clothes, speak the language, share the culture and remain mentally in their former professions. Still, it is central that they keep up this contact to be able to school the pupils into the environment of the trade in question, but also to help them to understand what skills a profession demands. However, the individual teacher also has to distance himself from the negative elements in the culture of the profession: patterns and habits that, for various reasons, have to be broken or changed. This paper draws attention to the ways in which a group of vocational teachers, who were participants in a project that aimed to train unauthorized vocational teachers, expressed their ambitions to prepare the pupils for a future professional career. When collecting information, we used the degree dissertations they produced and discussed in seminars, and informal dialogues. The result shows that it is important that the instruction location resembles a real working site as far as possible. These places are more or less realistic copies of a garage, a restaurant kitchen, a hairdressing salon, and so on, in order to give the pupils a realistic setting for instruction. However, the fact that these simulated workplaces lack the necessary support functions that exist in a company creates problems, problems which make a lot of extra work for the teachers. Vocational teachers also have to instruct the pupil in the experienced practitioner’s professional skills and working situation, but the pupil herself/himself must learn the job by doing it in practice. Some vocational upper secondary programs lack relevant course literature and the businesses give little support. This also makes extra work for the teachers. Moreover, the distance between the vocational programs and the trainee jobs was experienced as being difficult to overcome. One reason seems to be differences between businesses and differing preconditions between small and big companies’ abilities to take care of these pupils. The upper secondary school vocational programs also play a role in cementing existing gender roles, as well as perpetuating class-related patterns on the labour market.

How initial vocational education and training (IVET) teachers in Sweden perceive their prospects of being able to prepare upper secondary school pupils for a future occupation

Vocational teachers in Swedish upper secondary schools are a heterogeneous category of teachers, connected to different types of trade. These teachers represent a broad set of trade skills varying in content and character. In their teacher role, they continue to wear the clothes, speak the language, share the culture and remain mentally in their former professions. Still, it is central that they keep up this contact to be able to school the pupils into the environment of the trade in question, but also to help them to understand what skills a profession demands. However, the individual teacher also has to distance himself from the negative elements in the culture of the profession: patterns and habits that, for various reasons, have to be broken or changed. This paper draws attention to the ways in which a group of vocational teachers, who were participants in a project that aimed to train unauthorized vocational teachers, expressed their ambitions to prepare the pupils for a future professional career. When collecting information, we used the degree dissertations they produced and discussed in seminars, and informal dialogues. The result shows that it is important that the instruction location resembles a real working site as far as possible. These places are more or less realistic copies of a garage, a restaurant kitchen, a hairdressing salon, and so on, in order to give the pupils a realistic setting for instruction. However, the fact that these simulated workplaces lack the necessary support functions that exist in a company creates problems, problems which make a lot of extra work for the teachers. Vocational teachers also have to instruct the pupil in the experienced practitioner’s professional skills and working situation, but the pupil herself/himself must learn the job by doing it in practice. Some vocational upper secondary programs lack relevant course literature and the businesses give little support. This also makes extra work for the teachers. Moreover, the distance between the vocational programs and the trainee jobs was experienced as being difficult to overcome. One reason seems to be differences between businesses and differing preconditions between small and big companies’ abilities to take care of these pupils. The upper secondary school vocational programs also play a role in cementing existing gender roles, as well as perpetuating class-related patterns on the labour market.

Medical treatment and the good death: an ethical analysis of euthanasia, physician assisted suicide, and the right to die

Frequent advances in medical technologies have brought fonh many innovative treatments that allow medical teams to treal many patients with grave illness and serious trauma who would have died only a few years earlier. These changes have given some patients a second chance at life, but for others. these new treatments have merely prolonged their dying. Instead of dying relatively painlessly, these unfortunate patients often suffer from painful tenninal illnesses or exist in a comatose state that robs them of their dignity, since they cannot survive without advanced and often dehumanizing forms of treatment. Due to many of these concerns, euthanasia has become a central issue in medical ethics. Additionally, the debate is impacted by those who believe that patients have the right make choices about the method and timing of their deaths. Euthanasia is defined as a deliberate act by a physician to hasten the death of a patient, whether through active methods such as an injection of morphine, or through the withdrawal of advanced forms of medical care, for reasons of mercy because of a medical condition that they have. This study explores the question of whether euthanasia is an ethical practice and, as determined by ethical theories and professional codes of ethics, whether the physician is allowed to provide the means to give the patient a path to a "good death," rather than one filled with physical and mental suffering. The paper also asks if there is a relevant moral difference between the active and passive forms of euthanasia and seeks to define requirements to ensure fully voluntary decision making through an evaluation of the factors necessary to produce fully informed consent. Additionally, the proper treatments for patients who suffer from painful terminal illnesses, those who exist in persistent vegetative states and infants born with many diverse medical problems are examined. The ultimate conclusions that are reached in the paper are that euthanasia is an ethical practice in certain specific circumstances for patients who have a very low quality of life due to pain, illness or serious mental deficits as a result of irreversible coma, persistent vegetative state or end-stage clinical dementia. This is defended by the fact that the rights of the patient to determine his or her own fate and to autonomously decide the way that he or she dies are paramount to all other factors in decisions of life and death. There are also circumstances where decisions can be made by health care teams in conjunction with the family to hasten the deaths of incompetent patients when continued existence is clearly not in their best interest, as is the case of infants who are born with serious physical anomalies, who are either 'born dying' or have no prospect for a life that is of a reasonable quality. I have rejected the distinction between active and passive methods of euthanasia and have instead chosen to focus on the intentions of the treating physician and the voluntary nature of the patient's request. When applied in equivalent circumstances, active and passive methods of euthanasia produce the same effects, and if the choice to hasten the death of the patient is ethical, then the use of either method can be accepted. The use of active methods of euthanasia and active forms of withdrawal of life support, such as the removal of a respirator are both conscious decisions to end the life of the patient and both bring death within a short period of time. It is false to maintain a distinction that believes that one is active killing. whereas the other form only allows nature to take it's course. Both are conscious choices to hasten the patient's death and should be evaluated as such. Additionally, through an examination of the Hippocratic Oath, and statements made by the American Medical Association and the American College of physicians, it can be shown that the ideals that the medical profession maintains and the respect for the interests of the patient that it holds allows the physician to give aid to patients who wish to choose death as an alternative to continued suffering. The physician is also allowed to and in some circumstances, is morally required, to help dying patients whether through active or passive forms of euthanasia or through assisted suicide. Euthanasia is a difficult topic to think about, but in the end, we should support the choice that respects the patient's autonomous choice or clear best interest and the respect that we have for their dignity and personal worth.