Publikationer

 

Mina publikationer i Diva

  • Exploring the significance of interactive video games for physical activity among persons with psychiatric disabilities using experimental single case design

    Problem: Persons with psychiatric disabilities exhibit low levels of physical activity, which is a known general health risk factor. Nonetheless, physical activity is used far too little as health promotion in mental health care. Interactive video games are an emerging technology that can be used to increase physical activity levels. This study primarily aimed at exploring the significance of these games as a way to promote physical activity and health among persons with psychiatric disabilities.

    Method: Two participants played the interactive video game during an intervention for a period of 15 weeks. The study was conducted as a pilot study with a single case design and with an applied mixed methods approach.

    Results: Both participants increased their playing time during the intervention, and playing the game was experienced as fun, stimulating, and evolving. Through the challenge that the game provided, the participants’ motivation to continue playing seemed to be reinforced. Playing the game was found to strengthen the participants’ sense of capability and provided an experience of companionship with oneself.

    Conclusions: Being physically active in this manner enabled experiences of evolvement and competence, which could be considered an essential driving force of recovery and reconnection with one’s own life. The technique can therefore be regarded as an enabling tool for physical activity — however, the value of the support from another human being cannot be overlooked.

  • Experiences of a Recovery-Oriented Caring Approach to Suicidal Behavior : A single-case study

    Research considering the basis for mental health nurses wanting to enable recovery among people who suffer from suicidal behavior is sparse. The aim of this study is to explore and evaluate how a new recovery-oriented caring approach (ROCA) was experienced by a suicidal patient in a context of close relatives and nurses. A single-case study with a qual-quan mixed-method design was chosen. Participants were recruited from a psychiatric clinic in Sweden and consisted of one patient, one close relative to the patient, and three nurses. The results reveal that the ROCA enabled the patient to narrate, bear experiences of hopelessness, and ask for support, rather than view suicide as the only possible solution. ROCA has the potential to support patients, relatives, and nurses to develop a common language, considering the patient’s life situation and struggles and to use this as a source for the patient’s individual care planning.

  • Någon har rört vid mitt hjärta. Ur livskris och lidande till nya livsmöjligheter och hälsa : Slutrapport från en studie för ökad förståelse av lidande och hälsa hos hjärtopererade patienter. Ett Dagmar-projekt
  • Lidandet som kamp och drama

    Denna studie syftar till att via utformandet av en teoretisk modell nå ökad förståelse för hur människan erfar lidandet. Studien, som har en hermeneutisk ansats, fokuserar lidandet som drama och kamp, vilka beskrivs som lidandets form och substans.

    Data insamlades genom samtal med informanter från två kontext. Den ena informantgruppen som utgjordes av nio personer med drogrelaterade problem valdes med utgångspunkt i ett antagande om att missbruket härrör från ett livslidande. De övriga informanterna (nio stycken) söktes inom ett till det yttre kontrasterande kontext, de hjärtopererade patienternas. De texter dessa samtal genererade tolkades sedan med utgångspunkt i en hermeneutisk ansats, som hämtat metodologisk inspiration av Ricoeur och Helenius. Tolkningen ägde rum i flera steg och det meningsbärande söktes genom naiv tolkning, analys av textens struktur samt genom ett sökande efter alternativa tolkningar. Tolkningsprocessen resulterade en uppsättning teser vilka relaterades till undersökningens teoretiska perspektiv samt till en begreppsanalys av ’kamp’.

    Den teoretiska modellen tar fasta på lidandets kamp som en kamp mellan värdighet och skam, lust och olust. Denna kamp kan gestaltas i lidandets drama där människan på olika sätt söker lindring i lidandet. Detta kan ske genom att man försöker besegra lidandet, avtäcka det eller försonas med det. Ytterligare ett sätt att söka lindring är att ge upp lidandets kamp och resignera. I den teoretiska modellen gestaltas även hur människan kan förhålla sig till kampen på olika sätt beroende på vilket perspektiv hon har inför framtiden. Då människan uppfattar att framtiden präglas av ett hot om avskurenhet och död förhåller hon sig till livet på ett sådant sätt att lidandet dominerar. Om uppfattningen om framtiden präglas av liv och gemenskap kan hon förhålla sig till kampen som hälsa.

    När lidandet blir outhärdligt förlorar människan sin förankring i tiden. I och med att människan isoleras i nuet kan lidandet bemästras och begränsas till en konkret situation. För att en rörelse i hälsoprocesserna skall äga rum måste människan emellertid relatera till tiden. Relationen till en annan människa och skapandet av en lidandeberättelse innebär en möjlighet till förankring i tiden och därmed också till helande.

  • Hermeneutics and narration : a way to deal with qualitative data

    This article focuses a hermeneutic approach to the interpretation of narratives. It is based on the French philosopher Paul Ricoeur’s theory of interpretation but modified and used within a caring science paradigm. The article begins with a presentation of the theoretical underpinnings of hermeneutic philosophy and narration, as well as Ricoeur’s theory of interpretation, before going on to describe the interpretationprocess as modified by the authors. The interpretationprocess which consists of several stages is exemplified and discussed using a single case from a larger study on suffering. The results of that study indicate that the struggle of suffering is perceived as a struggle formed between shame and dignity, and that nurses must engage in the process of preserving and restoring the dignity of their suffering patients. The authors suggest that Ricoeur’s theory of interpretation is useful when trying to understand narrative data if the researcher realises that the process of distanciation, although central in Ricoeur’s thinking, is not the goal of the process but rather it is a means to deal with the researcher’s pre-understandings. According to Ricoeur, distanciation is accomplished by putting the context aside and dealing with the text “as text” and thereby explaining its meaning. Explanation thus becomes the dialectic counterpart to understanding in the interpretationprocess. The researchers further argue that distanciation must be followed by reflection where the interpretations are linked back to the empirical context.

  • Lidandets kamp
  • Vårdvetenskap i klinisk praxis
  • "The Anchor" - a treatment approach using cognitive psychotherapy from a caring perspective

    During the last few years there has been increasing demands on changes and higher effectiveness in mental health care. As a result, the Psychiatric Clinic in Gävle, Sweden, has made great effort to provide qualified psychiatric care outside the hospital. One step in this process was the opening of the day-care unit ”The Anchor” in May 2001. “The Anchor” is situated in the town centre (not at the hospital), and next doors to the community’s activity centre. As a consequence, the co-operation between different caregivers is strengthened, resulting in an increased possibility to provide care close to the patient’s home and every-day-living.

    The unit provides individual care as well as group-treatment for different kinds of mental suffering. The staff is all nurses or mental health assistants and the theoretical foundations are rooted in caring science. An approach inspired by cognitive therapy is used within the caring framework. The patient’s functional level and symptoms was estimated before and after treatment by the means of GAF and SCL-90, and shows significant improvements on the patients’ well-being.  Patient satisfaction was studied after treatment by means of a questionnaire, QPP (Quality from the Patient's Perspective).

    This way of organising the mental health care, and of using therapeutic methods from a caring perspective thus seams fruitful. The paper will give a brief presentation on the results, but focus on how the staff were prepared and the work organised.

  • Kognitivt förhållningssätt och vårdvetenskap -går de att förena?
  • Kognitivt förhållningssätt och vårdvetenskap – går de att förena?
  • Utvärdering Team Vågen
  • Omsorgsvidenskab i klinisk praksis
  • "A cognitive perspective on frequent attenders health and suffering"
  • Vilken typ av kunskap kännetecknar den skicklige terapeuten?
  • Suffering in addiction : a struggle with life

    This study aims at describing how the struggle of suffering, theorised in Eriksson's writings, is experienced within the context of drug addiction, and how the drama of suffering is expressed in this context. Narratives from nine participants were interpreted by means of a hermeneutic approach. The struggle of suffering could be conceived as a struggle with life, a struggle between shame and dignity threatening the person's experience of his/herself as authentic and whole. The conclusions are that addiction is not only the cause of suffering, but also means to handle it. Nurses thus must realise that suffering could be expressed and handled in unexpected ways, otherwise there is a risk for violating the patient's dignity and cause suffering instead of alleviate it

  • Kognitiv terapi med patienter som lider av personlighetsstörningar
  • "Och aldrig mötas de två" -en studie av 'vana patienters' lidande och deras möte med vården", Muntlig presentation
  • Meeting existential needs in caring for patients suffering from addiction. Muntlig presentation
  • När begreppen tar gestalt – hermeneutisk tillägnelse genom språk och metaforer
  • Different levels of interpretation in hermeneutic understanding

    This paper will focus a hermeneutic approach considering different levels of interpretations. The approach has its roots in Gadamer’s philosophy of understanding and is developed by Ödman and Söderlund. Within this tradition questions of meaning are central and linked to persons reciprocal interplay with the situation. Interpretations are made on three different levels; 1) rational interpretation, aiming at understanding persons’ motive for acting 2) structural interpretation focusing the contextual structure of which the research object is a part, 3) existential interpretation which focuses the existential world as the world of the text. Finally a synthesis of the whole is made which could be described in terms of appropriation of the texts meaning. Then the researcher’s and the object of interpretation’s horizons of meaning are merged in terms of a new understanding. The method will be illustrated using results from a study on experiences of living with addiction.

  • Att våga möta livet som sig själv – vårdandet vid missbruk
  • Resolving spiritual challenges in recovery from addiction

    Aim: This paper aims to explore the existential aspects of living with addiction.

    Background: The study focuses on research into addiction conducted within nursing science and takes as its point of departure the patient’s perspective. Addiction is described as being related to traumatic experience and to loss of control, shame, guilt and low self-esteem, but also to spirituality. This causes profound suffering, and drugs are used as a means of handling this suffering.

    Method: The study constitutes a secondary analysis of data derived from a study in 2000. It is based on interviews with people with rich, personal experience of addiction. Analysis was conducted using a hermeneutic approach.

    Findings: On an existential level the experiences of living with addiction can be understood as a striving to resolve the spiritual challenges caused by a person’s suffering and, paradoxically, also by his/her efforts to relieve that suffering through the use of drugs. These challenges are presented as existential themes focusing on the conflict that must be resolved; meaning – meaninglessness, connectedness – loneliness, life – death, freedom – adjustment, responsibility – guilt, control – chaos.

    Conclusion: Living with addiction appears as being in the midst of a struggle with existential challenges. Further more the use of drugs is paradoxical as it momentarily relieves suffering but at the same time increases it. To understand an addicted person’s health and suffering nurses must be aware of the existential aspects of being addicted and the spiritual challenges that must be addressed.

  • "New" knowledge for "old" nursing leaders

    During the last decades nurse-education has become more oriented towards scientific knowledge. Nursing-theories are taught at school and new nurses are prepared to use them in their clinical practice. However, when graduated and entering the clinical reality the nurses describe that this kind of knowledge are not always appreciated while experienced nursing leaders describes that the new nurses have a kind of knowledge that doesn’t always fit into the existing system. Thus, it is a problem when to different paradigms – one that is more practical and skill-oriented and one where actions are theory-driven – meets. What usually happens is that the new nurses either quit their work or adapt to the old system, thus preserving old knowledge and old routines instead of contributing to the development of nursing care in their units.

    In order to deal with this the county hospital and the university arranged an education for nursing leaders. The education, “Leadership on Good Caring” took place on advanced level during a five-month period. The nursing leaders was simultaneously working and given 8 credits when passing the examination seminars. In the course the leaders was given an introduction to the content in today’s nurse-education. The main parts of the course consisted in three integrated parts; caring science and nursing theories, building good teams, and approaches to care-development. During the first part focus was on the Finish nurse-theorist Eriksson’s theory of caritative caring, focusing issues relating to the importance of a basic value-system for the development of a caring culture. In their exams the leaders presented plans for how to implement nursing theory at their units in order not only to improve care but also to engage their teams in this process. This paper will not only describe the education but also what kind of projects it resulted in.

  • Existential aspects of living with addiction - Part I: meeting challenges

    AIM: This paper aims to explore the existential aspects of living with addiction.

    BACKGROUND: This study arises from data from a previous research project carried out by the author and takes as its point of departure the patient's perspective. Addiction is described as being related to traumatic experience and to loss of control, shame, guilt and low self-esteem, but also to spirituality. This causes profound suffering and drugs are used as a means of handling this suffering.

    DESIGN: Hermeneutic inquiry was used to explore peoples experiences of living with addiction.

    METHOD: The first study was based on interviews with people with rich, personal experience of addiction. This study constitutes a secondary analysis of the same data and was conducted using a hermeneutic approach.

    RESULTS: On an existential level the experiences of living with addiction can be understood as a striving to meet and resolve challenges associated with spirituality caused by a person's suffering and, paradoxically, also by his/her efforts to relieve that suffering through the use of drugs. These challenges are presented as themes focusing on the conflict that must be met; meaning - meaninglessness, connectedness - loneliness, life - death, freedom - adjustment, responsibility - guilt, control - chaos.

    CONCLUSION: Living with addiction appears as being in the midst of a struggle with existential challenges. Furthermore, the use of drugs is paradoxical as it momentarily relieves suffering but at the same time increases it.

    RELEVANCE TO CLINICAL PRACTICE: Addressing the challenges will facilitate nurses interaction with addicted persons. When facing challenges, including the motivational aspects, instead of focusing on problems, health can be promoted and suffering relieved.

  • Existential aspects of living with addiction - Part II: caring needs. : A hermeneutic expansion of qualitative findings

    AIM: This paper aims to describe caring needs associated with existential aspects of living with addiction.

    BACKGROUND: Spirituality is considered a driving force within and the concept relates to self, others and God and the relationships between them. The spiritual dimension is of great importance in both the addiction itself as well as in recovery and addressing caring needs relating to spirituality is important in nursing.

    DESIGN: Hermeneutic inquiry was used to explore caring needs related to peoples experiences of living with addiction.

    METHOD: This paper is a hermeneutic expansion of findings presented in Part I. Existential themes in the form of spiritual challenges and caring needs are reflected upon as a process between figure and background.

    RESULTS: The themes presented are: meaning - meaninglessness, connectedness - loneliness, life - death, freedom - adjustment, responsibility - guilt, control - chaos. Caring needs associated with them are identified as; the need to create a new frame of reference for interpreting of life, the need to experience coherence in life, a restored dignity as well as the need for a sense of community and attachment, confirmation and acceptance. The caring need for forgiveness and reconciliation is also identified as well as the need for continuity, comprehensibility and manageability.

    CONCLUSIONS: When caring for patients suffering from addiction nurses should address patients' spirituality. The caring communion is vital, as it is the foundation for meeting the patients' needs. Intervention by nurses should focus on aspects that will help patients feel alive and in communion with others.

    RELEVANCE TO CLINICAL PRACTICE: Understanding and being able to identify patients' caring needs associated with existential aspects of living with addiction will enable nurses to provide professional care and promote patient's recovery.

  • The drama of suffering as narrated by patients who have undergone coronary bypass surgery

    The struggle with suffering can be said to be at the centre of what can metaphorically be described as a drama. The study aims to establish whether the drama of suffering is conducted on different levels of health and suffering, and if so, to describe this suffering. Data was analysed using a narrative hermeneutic approach. The analysis revealed four different kinds of drama of suffering. They are described in terms of tragic, romantic, satiric or comic drama – the differences between them relating to different levels of health and suffering and to what the sufferer has to sacrifice to relieve suffering.

  • Perspektiv på lidande
  • Substansberoende
  • Att vara specialistsjuksköterska inom psykiatrisk vård
  • Glädje, kreativitet och nyfikenhet : resurser i patientens hälsoprocesser
  • Att balansera mellan värdighet och skam
  • Katie Erikssons teori som referenceramme for undersøgelse af lidelse og lidelsens drama
  • Beroende och frihet - vårdandets paradox
  • Vårdande vid psykisk ohälsa : på avancerad nivå
  • Metaphors – A Path to Narrative Understanding

    This article illustrates the process of narrative hermeneutic interpretation. Narratives could be analyzed and understood as text on different levels of interpretation. Analyzing narrative structure by means of emplotment focuses on how the story is narrated. Further understanding is promoted by analyses of narrative content – what the text talks about – and could be revealed by metaphors used by participants or constructed by the researcher. I will argue in favor of metaphors not only as analytic tools but also as means to communicate findings. Through their ability to make connections between language and body metaphors can facilitate appropriation of new understandings.

  • Att erhålla vetenskaplig kunskap genom berättelser : Datainsamling i narrativa studier

    Bakgrund: Som människor lever vi i en värld av berättelser. Att berätta är ett sätt att skapa mening genom att ordna och strukturera händelser, och berättelsen anses också ha en identitetsskapande natur. Detta sätt att se på världen får också konsekvenser för forskningen, då det ställer forskaren inför utmaningen att på bästa sätt återspegla denna subjektiva och konstruerade verklighet i forskningen. Inom vårdvetenskaplig forskning har olika narrativa metoder blivit allt vanligare för att utforska vårdverkligheten. Samtidigt kan man konstatera att litteraturen i hög grad fokuserar olika typer av narrativ analys. Mer sällan diskuteras narrativa data, och vad som kännetecknar dem.

    Frågeställning: Vilka överväganden bör göras i samband med datainsamling vid narrativa studier?

    Metod och resultat: Med utgångspunkt i en reflektion över den narrativa studien som ett hermeneutiskt projekt där olika förståelsehorisonter samspelar lyfts berättelsen fram som något som skapas i dialogen mellan forskaren och forskningspersonen och hur forskaren redan här måste göra vissa överväganden för att erhålla data som håller för en narrativ analys. Narrativa data är inte vilka kvalitativa data som helst, utan har vissa särdrag, och forskaren måste vara medvetna om dessa för att i samtalet kunna stödja berättelsen. Genom att berätta kan vi bringa ordning och sortera våra upplevelser, men berättandet medför också en risk för att de reduceras. Berättandet sker alltid i efterhand, och en narrativ intervju är inte bara ett åter-berättande av en händelse, utan en ny-gestaltning av den med utgångspunkt i personens aktuella förståelse av det som hände, vilket forskaren måste beakta såväl i samtalssituationen som vid analys av data.

    Slutsatser: Att berätta sträcker sig utöver informationsöverföring, det är ett sätt att relatera till en annan människa, något som också får etiska implikationer. Likaså kan konstateras att tillförlitligheten och kvalitén hos berättelserna framför allt är beroende av forskarens hållning, inte av forskningspersonens egenskaper.

  • Narrative Hermeneutics : In search of narrative data

    As human beings, we live in a storied world. This worldview requires us to think about how to re-present it in research. My purpose with this article is to reflect upon narratives from an ontological and epistemological point of view, taking Ricoeur's writings on narrative identity as a starting point. From this perspective, narration is an aspect of self-interpretation and self-understanding. Furthermore, self-understanding is not only achieved within our own narratives, but depends upon the regard, words and actions of others. This must be accounted for in our search for narrative data. Researchers would benefit from being alert to this and also aware of how narratives are co-authored in a dialogue with participants. Reflections on narration from this perspective could guide ethical considerations - and also methodological - as they could support questions that would create space for the narrative. Furthermore, the researcher must be aware that the quality and trustworthiness of narratives to a high degree depend on the researcher and not only on the participant.

  • Being altruistically egoistic :  Nursing aides’ experiences of caring for older persons with mental disorders

    Older persons with mental disorders, excluding dementia disorders, constitute a vulnerable group of people. With the future international increase in the older population, mental disorders will increase as well, thus entailing new challenges for their caregivers. These older persons often remain in their own homes, and in Sweden they are cared for by nursing aides. With little previous research, an increased workload and facing new strenuous situations, it is important to make use of the knowledge the nursing aides possess and to deepen the understanding of their experiences. The study aimed at illuminating the meaning of caring for older persons with mental disorders as experienced by nursing aides in the municipal home help service. Interviews with nine female nursing aides were performed and analysed with a phenomenological hermeneutical research method inspired by the philosophy of Paul Ricoeur. Being altruistically egoistic emerged as a main theme in the nursing aides’ narratives. The nursing aides’ experiences could be interpreted as a movement between being altruistic and egoistic. The findings revealed a continuous distancing by the nursing aides and their struggle to redress the balance between their altruistic and egoistic actions. Caring for these older persons constitutes a complex situation where distancing functions as a recourse to prioritize oneself and to diminish the value of caring. The study suggests that an increased knowledge base on older persons with mental disorders, followed by continuous supervision, is necessary for the nursing aides to improve the quality of the care given

  • Implications for theory : a challenge for researchers?
  • Mental disorders affect older persons in Sweden : a register-based study

    OBJECTIVE: The study aimed to estimate the prevalence of mental disorders based on pharmaceutical use among the old (age >/= 65) in Sweden for the years 2006-2008. METHODS: Data on the mental health of older persons were approximated on the basis of recommended prescriptions for pharmaceuticals, gathered from the Swedish Register on Prescribed Pharmaceuticals (SRPP). Each disorder (ICD-10, F20-F42, and F60-F61) was analyzed to identify associated recommended pharmaceuticals. Anatomical Therapeutic Chemical Classification codes were applied. The data covered 188 024 individuals who received 2 013 079 prescriptions for pharmaceuticals for mental disorders during a 3-year period. Persons with pharmaceuticals for dementia disorders were excluded from the calculations of the prevalence of mental disorders. RESULTS: The prevalence of mental disorders among the old in Sweden, measured on the basis of pharmaceutical use, was 6.6% in 2006, 2007, and 2008, respectively. Men constituted one-third of cases and women two-thirds. Prevalence was lowest in the age group 65-69 and increased subsequently with age. CONCLUSIONS: This fundamental register-based study included a great number of older persons and shows that mental disorders affect every fifteenth older person in Sweden. The prevalence of mental disorders increases with increasing age. The results highlight the extent of mental disorders among older persons, which is important to know when planning care for these patients. This study, by investigating a large population, provides a solid basis for general planning as well as for future mental disorder research. Copyright (c) 2010 John Wiley & Sons, Ltd.

  • To intend but not being able to : frequent attenders' experiences of suffering and of their encounter with the health care system

    PURPOSE: Patients who frequently consult the health care system are supposed to      cause great economic costs, and they also trouble the health care staff, as it      seems as if there are no interventions that will help and keep them healthy. The       researcher assumes that these patients attend for a reason and that they attend      frequently because they, from a holistic point of view, do not get their health      care needs fulfilled. This article aims to describe how frequent attenders      experience their suffering and their encounter with the health care system.      DESIGN AND METHOD: The study has an inductive hermeneutic design. Interviews with      persons identified as frequent attenders were analyzed by means of a hermeneutic       inquiry with three interpretive steps: naive reading, structural analysis, and      critical reflection. FINDINGS: Patients are constantly striving to be and become       healthy, to be of use, and to please others. The patients do not attend until      suffering is experienced as unbearable. The patients experience, however, that      health care staff do not understand their situation. Patients experience feelings      of mistrust and rejection, which increases suffering. CONCLUSION: Holistic care      could be a means to relieve suffering and, as a consequence, reduce attendance.

  • The meaning of reconciliation : Women’s stories about theirexperience of reconciliation with suffering from grief

    Introduction: Grief can be seen as a form of suffering. In this study grief was not only defined as loss, but as the process of inner suffering caused of some kinds of loss. We must recognise the importance of increased understanding for patient reconciliation with grief to expand earlier formulated knowledge about health and suffering. The aim in this study was ti illuminate the meaning of reconciliation among women suffering from grief.

    Methods:A qualitative explorative design with a hermeneutic narrative approach was used to analyse and interpret the interviews. Caring theory abouth health, suffering and hermeneutical philosophy about understanding provided the point of departure for the analysis. The study was approved by an ethical research committé.

    Results:Findings reveal different plots that give light to the meaning of reconciliation in the different phases of analysis. In the Women´s narratives the meaning of reconciliation is a process to a new way of seeing, but also to opening and transition from the experience of grief and suffering to the experience of health and holiness.

    Conclusions: Reconciliation has a progressive form and the meaning of reconciliation cannot be seen as synonymous or homogenous but an understanding of reconciliation as a heterogenic synthesis of health and suffering. Understanding the reconciliation process will enable nurses to plan and provide professional care, based on caring science.

  • Vårdvetenskapliga begrepp i teori och praktik

    En vetenskap och dess teorier byggs upp av olika begrepp som på olika sätt relaterar varandra och beskriver vetenskapens sätt att se på den egna verksamheten. Tillsammans formar begreppen en syn på verkligheten som kan te sig mer eller mindre abstrakt, samtidigt som abstraktionsnivån också bidrar till att teorier kan ha såväl djup som omfång. Begrepp utvecklas, bestäms och definieras därför i regel genom olika typer av forskning. I den här boken fokuseras begrepp som anses viktiga inom vårdvetenskapen, och ett par metoder för hur begrepp kan utvecklas inom ramen för en vårdvetenskaplig tradition presenteras.

    Huvuddelen av boken beskriver olika begrepp som utvecklats av forskare från Sverige, Finland och Norge. Kapitlen inleds med begreppens innebörd och användning i vårdvetenskaplig forskning och teoribildning. Därefter relateras begreppet till olika kliniska situationer för att belysa hur en förståelse för begreppets innebörd kan vara till stöd för vårdarens reflektion. Både övergripande begrepp som exempelvis hälsa och vårdande och mer avgränsade begrepp som vila, vårdande kommunikation och ansvar tas upp innan boken avslutas med ett kapitel om hur man via reflektion kan lära sig att förstå och använda sig av vårdvetenskapliga begrepp.

    Boken vänder sig främst till studerande i sjuksköterskeutbildningen, men passar också andra som är intresserade av att förstå mer om vårdvetenskap i allmänhet, och om dess begrepp och språkanvändning i synnerhet.

  • Medlidande
  • Katie Erikssons teori som referensram för förståelsen av lidande och lidandets drama
  • Omvårdnadsteori i klinisk praxis

    Trots att såväl vårdpersonal som utbildningsanordnare och lagstiftare talar om att vården ska utgå från en helhetssyn på patienten tycks detta perspektiv ofta falla bort då man talar om evidens- eller kunskapsbaserad vård. Detta vill författarna till Omvårdnadsteorieri klinisk praxis råda bot på. I boken visar de huromvårdnad kan kunskapsbaseras utifrån fokus på vårdandet av människor och sjuksköterskans självständiga professionsansvar.

    De teorier som tas upp har utvecklats av Phil Barker, Katie Eriksson, Virginia Henderson, Madeleine Leininger, Dorothea Orem, Sister Calista Roy, Rosie-Marie R. Parse och Jean Watson. Teorierna relateras till olika åldersgrupper och vårdkontexter, till exempel perioperativ vård, primärvård, palliativ vård, kirurgisk vård, medicinsk vård och psykiatrisk vård, liksom till olika aspekter av vård: patientens perspektiv, vårdande relationer, hälsa och lidande, etik, behov, adaption, egenvård och kultur

  • KBT i omvårdnadsarbetet : om meningsskapande i gemenskap

    Alla sjuksköterskor arbetar med hälsofrämjande och vårdande samtal av olika slag. Denna bok är den första som beskriver hur KBT kan vidga sjuksköterskans repertoar i mötet med patienten. I fokus står sjuksköterskans och patientens gemensamma arbete,som beskrivs som en meningsskapande process där patienten kan utveckla sin förmåga att hantera utmaningar och problem i livet.

    Boken innehåller teoretiska texter som placerar KBT i ett omvårdnadssammanhang. Dessa kombineras med beskrivningar av olika metoder och tekniker från KBT-området,övningsuppgifter och reflektionsrutor. Till boken hör även en webb med kompletterande material.

    Boken vänder sig främst till sjuksköterskor och sjuksköterskestuderande, men även andra yrkeskategorier som arbetar med samtal kan ha behållning av boken. Den kan också läsas av KBT-terapeuter som handleder omvårdnadspersonal och som vill öka sin förståelse för det vårdvetenskapliga perspektivet.

  • Experiential and Reflective Learning of Caring Theory

    Reflective and experiential learning is put forth as essential for understanding caring (Johns, 2009), and could also be understood as a way to recognize multiple ways of knowing and create genuine teaching-learning experiences.

     

    In this project a group consisting of eight nursing teachers met for ten one and a half hour long sessions, aiming to enhance participant’s ability to deal with stress in daily life by exploring personal thoughts and feelings and how they contribute to every-day-stress, as well as developing a more mindful and authentic way of living in line with personal values. Between each session participants assign themselves to “homework” focusing different kinds of self-care.

     

    After each session and a break for personal reflection and refreshment participants joined again in order to reflect upon their experiences in relation to Watson’s (2008) ten caritas processes. Basic learning principle adopted from Kolb (1984), i.e. to have an experience and make observations during that experience, to reflect on the experience, make theoretical links and finally plan how to implement the new understanding aimed as a didactic framework in order to enhance learning and understanding.

     

    The poster presents the structure and content of these sessions, and findings from an evaluation of the project, focusing on what aspects that contributed to learning and understanding Caring Theory.

  • Specialist prescribing of psychotropic drugs to older persons in Sweden : a register-based study of 188 024 older persons

    Background

    The situation for older persons with mental disorders other than dementia disorders has scarcely been studied. The older population is increasing worldwide and along with this increase the prevalence of mental disorders will also rise. The treatment of older persons with mental disorders entails complex challenges, with drugs constituting the major medical treatment. Knowledge of geriatric psychiatry is essential for providing older persons with appropriate treatment and care. This study aimed to evaluate the prescription of drugs for mental disorders to older persons (>=65) in Sweden, focused on the medical specialties of the prescribing physicians.

    Methods

    Data concerning drug treatment for older persons from 2006 to 2008 was gathered from the Swedish Prescribed Drug Register. Mental disorders, defined as affective, psychotic and anxiety disorders (ICD-10 F20-42) were evaluated in order to identify associated drugs. Included was a total of 188 024 older individuals, who collectively filled 2 013 079 prescriptions for the treatment of mental disorders. Descriptive analyses were performed, including frequency distribution and 95% CI. The competence of the prescribers was analyzed by subdividing them into five groups: geriatricians, psychiatrists, general practitioners (GPs), other specialists, and physicians without specialist education.

    Results

    GPs represented the main prescribers, whereas geriatricians and psychiatrists rarely prescribed drugs to older persons. Benzodiazepines and tricyclic antidepressants were the most commonly prescribed drugs. Women were prescribed drugs from geriatricians and psychiatrists to a greater extent than men.

    Conclusions

    This study examined the prescription of psychotropic drugs to older persons. Physicians specialized in older persons' disorders and mental health were rarely the prescribers of these drugs. Contrary to clinical guidelines, benzodiazepines and tricyclic antidepressants were commonly prescribed to older persons, emphasizing the need for continuous examination of pharmaceutical treatment for older persons. The results indicate a future need of more specialists in geriatrics and psychiatry.

  • Struggling for existence : - Life situation experiences of older persons with mental disorders

    Older persons with mental disorders represent a vulnerable group of people with extensive and complex needs. The older population is rapidly increasing worldwide and, as a result of deinstitutionalization in mental health care, older persons are remaining at home to a greater extent. Although they constitute a large proportion of the population, older persons with mental disorders have been neglected in research as well as in care organizations. As there is little previous knowledge concerning older persons’ experiences of their own situations, this study aimed to illuminate the meaning of the life situation as experienced by older persons with mental disorders (excluding dementia disorders). Interviews were conducted with seven older persons and the text was analyzed using a phenomenological hermeneutical research method, inspired by the philosophy of Paul Ricoeur. ‘‘Struggling for existence’’ emerged as a main theme in the older persons’ narratives, understood as a loss of dignity of identity and involving being troubled and powerless as well as yearning for respect. The older persons fought to master their existence and to be seen for who they are. The study highlights the importance for caregivers, both formal and informal, to avoid focusing on the diagnoses and rather acknowledge the older persons and their lifeworld, be present in the relation and help them rebuild their dignity of identity. This study brings a new understanding about older persons with mental disorders that may help reduce stigma and contribute to planning future mental health care

  • The butterfly effect of caring : clinical nursing teachers’ understanding of self-compassion as a source to compassionate care

    This study has its roots in a clinical application project, focusing on the development of a teaching–learning model enabling participants to understand compassion. During that project four clinical nursing teachers met for a total of 12 hours of experiential and reflective work. This study aimed at exploring participants’ understanding of self-compassion as a source to compassionate care. It was carried out as a phenomenological and hermeneutic interpretation of participants’ written and oral reflections on the topic. Data were interpreted in the light of Watson’s Theory of Human Caring. Five themes were identified: Being there, with self and others; respect for human vulnerability; being nonjudgmental; giving voice to things needed to be said and heard; and being able to accept the gift of compassion from others. A main metaphorical theme, ‘the Butterfly effect of Caring’, was identified, addressing interdependency and the ethics of the face and hand when caring for Other – the ethical stance where the Other’s vulnerable face elicits a call for compassionate actions. The findings reveal that the development of a compassionate self and the ability to be sensitive, nonjudgmental and respectful towards oneself contributes to a compassionate approach towards others. It is concluded that compassionate care is not only something the caregiver does, nor is compassion reduced to a way of being with another person or a feeling. Rather, it is a way of becoming and belonging together with another person where both are mutually engaged and where the caregiver compassionately is able to acknowledge both self and Other’s vulnerability and dignity.

  • Self-reported health and physical activity among community mental healthcare users

    The aim of the study was to survey the self-reported health and physical activity in a sample of community mental healthcare users in a city of Sweden. The study was conducted through a cross-sectional design with participants requested to fill out a self-report questionnaire. Participants (n =103) were persons with psychiatric disabilities living in residential psychiatric settings and/or participating in daily activities provided by community mental healthcare services. The results showed that the group is affected with serious risk factors, such as high body mass index, low rated extent and frequency of physical activity and low self-estimated general state of health. Even though some difficulties associated with the answering process of this questionnaire emerged, these self-reported results clearly confirm the fact that persons with psychiatric disabilities constitute a vulnerable group in need for health-promoting caring activities and interventions.

  • Moving toward Reclaiming Life : Lived Experiences of Being Physically Active Among Persons with Psychiatric Disabilities

    There is abundant documentation in research about the significant relationship between physical activity and mental health, but there is still more to be learned about what can enhance motivation to become more physically active. Fourteen persons with psychiatric disabilities were interviewed about their experiences of being physically active, and data was analyzed using a phenomenologicalhermeneutic method. Five themes emerged: Capability for Living, Liberation from a Heavy Mind, Companionship in Being in Motion, Longing for Living One’s Life, and Struggling with Limitations. The interpreted meaning of being physically active was to be moving toward reclaiming one’s life.

  • Struggling on My Own : A Cognitive Perspective on Frequent Attenders' Perceptions of LIfe and Their Interaction with the Health Care System

    Different studies reveal that a large percentage of people frequently attending healthcare not only suffer from diffuse somatic symptoms but also from psychological distress and difficulties in dealing with everyday life. Even though they are not always diagnosed with psychiatric disease, questions arise about their mental health. The study aims at describing frequent attenders’ conceptions of life, and as a result their health, from a cognitive perspective. A qualitative content analysis of in-depth interviews was carried out with nine service users in primary healthcare. The findings reveal that participants experience themselves as inadequate and as being a burden for others, by whom they experience rejection, in different ways. In order to take part in community with others the person develops compensatory strategies that aim at concealing their inadequacies, thus also preventing them from sharing their suffering with others. The consequence is that the persons become even more alienated as they start to relate to others through a façade and furthermore are unable to either improve their health or obtain adequate care. It can be concluded that these patients need to be taken seriously in order to prevent further psychological suffering

  • Development of suicide prevention based on a lifeworld perspective
  • Metaphors as means to synthesize and communicate research findings

    Objective During the last two decades research has put forth recovery as an important focus for mental health nursing. These studies describe different aspects of recovery, and without doubt they have contributed to the recovery movement in mental health care. The present study aims at synthesizing research findings in order to promote understanding of recovery as a phenomenon.

    Methods Qualitative research focusing recovery provided data for the synthesis. The synthesis is based on Noblit & Hare’s description of meta ethnography, and focus is put on synthesising findings from different qualitative methods. The focus of the presentation will be put on the method and how metaphors can be used as means to synthesize and communicate research findings.

    Results Findings in the form of metaphors describing the process of recovery, and how recovery is experienced, will be used in order to illuminate the method.

    Conclusion Recovery could metaphorically be described as a process towards reclaiming life, a journey from experiences of being list to feeling at home with oneself. Metaphors is concluded a fruitful tool to describe and communicate this process.

  • Ömsesidighet och ”compassion” som grundförutsättningar för psykiatrisk omvårdnad
  • Att förstå något genom något annat - metaforer i narrativ hermeneutik
  • Substansbrukssyndrom

    Boken presenterar översiktlig kunskap om psykisk ohälsa, psykiatriska sjukdomar och individers problematik rörande psykisk ohälsa. Den första delen fokuserar på de mest förekommande ohälsoproblemen inom psykiatrisk vård. Den senare delen belyser viktiga områden som har betydelse för hur vården kring patienten kan förstås och hanteras, såsom vårdens miljö och organisation, attityder kring psykiska dilemman, närståendes medverkan och kvalitetsarbete inom psykiatrisk vård. I fokus står den unga, den vuxna och den äldre individen och dennes problematik. Utgångspunkten är ett omvårdnadsperspektiv med hänvisningar till omgivande områden såsom medicin, sociologi, farmakologi och psykologi. Det genomgående perspektivet är omvårdnad vid psykisk ohälsa, även om de konkreta åtgärder som beskrivs också kan inspirera och vägleda andra professioner i deras hälsoarbete.

    Boken vänder sig främst till studenter i grundutbildningen till sjuksköterska, men den kan också med fördel användas inom utbildningar med inriktning mot folkhälsa samt av kliniskt verksamma sjuksköterskor inom kommunal vård och primär- eller specialistvård.

    Omvårdnad vid psykisk ohälsa – på grundläggande nivå omfattar också en digital del. Vid sidan av den digitala versionen av boken finns material som underlättar studierna i form av kapitelsammanfattningar, övningar och sluttest. Instruktioner för hur du kommer åt det digitala materialet finns på omslagets insida.

  • Specialistsjuksköterska inom psykiatrisk vård

    Behovet av specialistutbildade sjuksköterskor ökar. I den här boken presenteras tolv utbildningar som leder till en examen som specialistsjuksköterska eller barnmorska. Vidare ger boken en inblick i vad de olika yrkena innebär. Boken presenterar arbetsplatser och karriärvägar och ger också konkreta exempel på vad specialistsjuksköterskor eller barnmorskor kan komma att möta en vanlig dag på jobbet. Därutöver presenteras Högskoleverkets examensmål för respektive inriktning samt länkar till fastställda kompetensbeskrivningar.

    Boken, som är skriven av sjuksköterskor med mångårig klinisk erfarenhet från olika specialistområden, riktar sig i första hand till grundutbildade sjuksköterskor som funderar på att fortbilda sig och erbjuder en inblick i såväl utbildning som yrke.

    De utbildningar som finns beskrivna är: Ambulanssjukvård, Anestesisjukvård, Barn och ungdom, Barnmorska, Distrikt, Intensivvård, Onkologisk vård, Kirurgisk vård, Medicinsk vård, Operationssjukvård, Psykiatrisk vård samt Vård av äldre.

  • Vårdande vid psykisk ohälsa : På avancerad nivå

    Boken ger läsaren en grund för personcentrerad vård på avancerad nivå, genom att ta fasta på forskning som beaktar patientens och närståendes livsvärld. En historisk tillbakablick på hur det har varit att vara patient inom den psykiatriska vården inleder boken, innan författarna presenterar aktuell forskning om hälsa, ohälsa och vårdande. Utgångspunkten tas i vårdvetenskaplig forskning som utgår från patienters erfarenheter av lidande och vård.

    Återhämtning som en pågående process där personen formar sitt liv utgående från sina egna förutsättningar och värden löper som en röd tråd genom boken. Teman som exempelvis hopplöshet, skam och utanförskap men även positiva erfarenheter av glädje, tillit och gemenskap relateras till ohälsa och lidande, men också till försoning, hälsa och återhämtning. Vårdarens betydelse för att främja patientens hälsoprocesser lyfts fram med fokus på vårdkulturen, vårdande relationer och kommunikation mellan patienter och vårdare.

    I denna andra upplaga av boken har de tidigare kapitlen omarbetats och uppdaterats med ny forskning och flera kapitel har tillkommit. I de nya kapitlen lyfts vårdande på avancerad nivå också fram i relation till de komplexa situationer som uppstår exempelvis på en vårdavdelning, där patienters olika behov ska tillgodoses. Maktstrukturer relaterade till såväl genus som förhållningssätt beskrivs och problematiseras. Dessutom synliggörs betydelsen av att möjliggöra såväl patienters som närståendes delaktighet för att främja återhämtning och ett bärkraftigt vardagsliv.

    Målgruppen är i första hand studenter på avancerad nivå samt sjuk-sköterskor inom den psykiatriska vården. Boken kan också med fördel läsas av andra inom hälso- och sjukvården som är intresserade av att få en inblick i hur den psykiatriska vården kan förstås med utgångspunkt i patientens värld snarare än utgående från diagnostiska kriterier.

  • Glädje, kreativitet och nyfikenhet - resurser i patietnens hälsoprocesser
  • Att balansera mellan värdighet och skam
  • Att närma sig det svårförståeliga
  • Beroende och frihet
  • Att använda sin specialistkompetens i patientens tjänst
  • Motivation does not come with an ending-it's the beginning of something new : Experiences of motivating persons with psychiatric disabilities to physical activity

    Despite strong evidence for the positive relationship between physical activity and mental health, physical activity is used far too little to promote health in mental health care. Fourteen caregivers working in community mental health services were interviewed about their experiences of motivating adult persons with psychiatric disabilities to be physically active, and data were analysed using a phenomenological-hermeneutical approach. Three themes emerged: (1) An approach of conscious acts, (2) Companionship as a joint creation, and (3) Understanding as a way to create meaning. The interpreted meaning of motivating to physical activity was expressed as a dynamic way of being, relating, and understanding.

  • Blessed Alienation : The Christian Monastery as a Caring and Restorative Environment

    Being mentally ill is often associated with experiencing alienation from society because sensations are not easily shared with others. Modern health care leads us to pose many questions. Some sufferers search and find their way to monasteries as they did centuries ago. We interviewed six persons staying in a monastery to understand the meaning of health and care in a monastic environment in contemporary Sweden. We analyzed the transcripts by means of a hermeneutic approach and discovered that the helping effect of the monastery was based on its contradictory/paradoxical structure that corresponded to the lifeworld of a person suffering from mental illness. The monastery was a place where one could be different but equal, and simultaneously provided freedom within boundaries, calmness and intensity, privacy and relations, demands and confirmation. This facilitated experiences of health and wholeness, necessary to manage the challenges of recovery.

  • Living in negotiation : patients’ experiences of being in the diagnostic process of COPD

    Purpose: To illuminate patients’ lived experiences of going through the process of being diagnosed with chronic obstructive pulmonary disease (COPD). Patients and methods: A phenomenological-hermeneutic analysis was applied in the inter- pretation of interviews with eight persons diagnosed with mild or moderate COPD.

    Results: One main theme ‘living in negotiation’, and three themes ‘living with a body out of step with the diagnosis’, ‘dealing with the past’, and ‘being challenged by the future’ reflected the process participants were living through in their quest for acceptance and a new balance in life. Participants found that the diagnostic processes were confusing, and that the diagnosis itself was ‘a slap in the face’. Unclear messages gave rise to fluctuating between an under- standing of the condition as ‘not too severe’, insecurity, and fear. Shame and guilt related to the diagnosis had origins in the past, and in combination with the idea of ‘chronic’ the COPD diagnosis interfered with the present moment and gave rise to uncertainty for the future. The understanding of the present is related to negotiations not only with the past, but also with the future. Thus temporal aspects of the diagnosis are of great significance for the process of finding acceptance.

    Conclusion: Regardless of disease severity, the diagnosis seems to be a breakdown of life, which puts life itself at stake. Medical professionals should be aware that the way the diagnosis is disclosed and communicated has considerable significance for how individuals understand and deal with their illness. The diagnosis should be communicated face-to-face, clearly and with empathy, and followed by information about COPD. Physicians should allow time and listen to the patients’ stories, and thus develop a shared understanding of the temporal aspect of the illness and patients’ needs and concerns. Thus, good communication is essential in determin- ing whether the patient remains in negotiation, or enters a process toward acceptance and new understanding.

  • Å leve i forhandlinger – Pasienterfaringer av å være i den diagnostiske prosessen med å få diagnosen KOLS
  • Utprøving av Klient- og Resultatstyrt praksis (KOR) i tverrfaglig spesialisert rusbehandling på døgninstitusjon ved Nordlandsklinikken

    Psykoterapiforskning viser at mesteparten av det som spiller en rolle for bedring fra psykiske lidelser foregår i klientens hverdagsliv og i relasjonen til terapeuten. ”Partners for change outcome management system” (PCOMS; https://heartandsoulofchange.com/norway.php) er utviklet med henblikk på å få fatt i og å jobbe med disse to faktorene. I praksis gjør man dette ved utgangspunkt i to spørreskjema som på norsk kalles for Klient- og resultatstyrt praksis (KOR). KOR er vesentlig forskjellig fra andre evidensbaserte tiltak ved at det kan anvendes på tvers av diagnostiske grupper og metoder.

    Bruk av KOR i polikliniske settinger viser gode effekter. Ingen har derimot undersøkt hvorvidt KOR også kan egne seg i en rusdøgnbehandlingsinstitusjon. Vi ville finne ut om henholdsvis terapeutene og klientene får til å fylle ut skjemaene etter hver samtale, å snakke om resultatene, og om det oppleves som nyttig for behandlingen å gjøre det. Våre tre hovedutfallsmål var (1) drop-out, eller rettere sagt, prediksjon og forebygging av frafall fra behandlingen før den er planlagt avsluttet, (2) symptombedring, og (3) opplevd nytte. Kvalitative data ble også samlet inn og sett i sammenheng med de kvantitative for å forsøke å belyse om og hvordan behandlerne endrer sin praksis ved innføring av KOR.

    Siden kun 5% av pasientene i prosjektperioden hadde fått registrert dato og grunn for avslutning av behandling, kunne vi ikke teste vår hovedhypotese; hvorvidt KOR bidrar til reduksjon av frafall fra behandling. Og i det store og det hele fikk vi ikke ut de kvantitative data vi hadde håpet på i dette prosjektet. Vi presenterer likevel vårt opprinnelige design i sin helhet i håp om at andre kan finne noe av nytte der for planlegging av fremtidige studier.

    I de kvalitative intervjuene fortalte imidlertid pasientene at de opplever KOR som et godt verktøy som bidrar til å gjøre behandlingen mer rett på sak og at de får større innvirkning på den. Det ble dog pekt på utfordringer som vi fortolker som et gjenstående behov for veiledning i bruken av KOR, altså at de fleste negative erfaringene pasientene hadde, som å bli redusert til et nummer, handlet om at KOR ikke ble anvendt i tråd med intensjonen. Dette ble også bekreftet i avslutningsmøte med koordinatorene; at de ønsket at vi hadde tilbydd mer informasjon og veiledning i starten av prosjektet.

    De kvalitative intervjuene med behandlerne tyder på at behandlerne opplever at KOR er et godt verktøy på mange vis, men at det i sin nåværende form ikke helt passer i døgnbehandling. Nordlandsklinikken har imidlertid valgt å innføre bruk av KOR som standard praksis ved poliklinikken.

  • To do good might hurt bad : Exploring nurses' understanding and approach to suffering in forensic psychiatric settings

    Patients in forensic psychiatric settings not only have to deal with their mental illness, but also memories of criminal activities and being involuntarily hospitalized. The aim of the present study was to explore how nurses working in forensic psychiatric services understand and approach patients' experiences of suffering. Data were generated by semistructured interviews with psychiatric nurses from two different forensic psychiatric units in Sweden. Data were analysed by means of a hermeneutic approach inspired by Ricoeur's hermeneutics. The findings are reflected in four main themes: (i) ignoring suffering; (ii) explaining suffering as a natural and inevitable part of daily life in the forensic context; (iii) ascribing meaning to suffering; and, (iv) being present in suffering. To engage in alleviating suffering is a struggle that demands courage and the strength to reflect on its character and consequences. To encounter suffering means that nurses are not only confronted with patients' suffering, but also their own reactions to those patients. If suffering is not recognized or encountered, there is a risk that actions may have a negative impact on patients.

  • Psykologi för sjuksköterskor

    Psykologi för sjuksköterskor är en bok som introducerar psykologiska teorier och begrepp som har relevans för förståelse av människan som patient, närstående och personal i vården. Olika psykologiska inriktningar beskrivs, liksom psykologiska teorier och begrepp som kan bredda sjuksköterskans kunskap om hur människor fungerar psykologiskt och på det viset ge reflektionsunderlag genom hela vårdprocessen. Ambitionen är att boken ska underlätta för sjuksköterskan att använda psykologiska teorier med utgångspunkt i sitt eget professionsansvar och det omvårdnadsvetenskapliga perspektiv som professionen vilar på. Därför relateras de teman som tas upp i boken såväl till omvårdnadens konsensusbegrepp som till omvårdnadsteorier. Några av de teman som berörs i boken är enheten kropp och själ, känslor, minne och meningsskapande. Andra teman berör interpersonella processer som relationer, kommunikation och medkänsla. Psykologiska aspekter på hälsa, ohälsa och sjuksköterskans hälsofrämjande arbete beskrivs också, liksom mer konkreta råd relaterade till bland annat informationsgivning, målformuleringar och problemoch konfliktlösning.

    Till boken hör en webbplats där bland annat kapitelsammanfattningar i form av bildspel, övningsuppgifter och tester bidrar till lärandet. Instruktioner för hur du kommer åt webbmaterialet finns på omslagets insida.

    Boken riktar sig främst till studerande i sjuksköterskeutbildningen. Den kan också vara till glädje för kliniskt verksamma sjuksköterskor och användas i specialistsjuksköterskeutbildningar.

  • Psykologi for sykepleiere

    Psykologi for sykepleiere introduserer psykologiske teorier og begreper som er viktige for å forstå mennesket som pasient, pårørende og sykepleier. Boken tar for seg kunnskap som er relevant for sykepleierens yrkesutførelse, og er dermed noe mer og noe annet enn en lightversjon av en grunnbok i psykologi.

    Forfatteren begynner med å presentere de viktigste psykologiske retningene og omsorgspsykologien som et delområde innenfor omsorgsforskningen og et støttefag i sykepleien. Utover i boken tar hun opp forskjellige temaer med utgangspunkt i konsensusbegrepene som er utviklet innenfor helse- og omsorgsvitenskapen (menneske, miljø, helse, pleie og omsorg). Dermed kommer fragmenter fra én og samme psykologiske teori igjen flere steder i boken, der de er aktuelle i sammenheng med tematikken. Hele veien viser forfatteren til sykepleieforskere som har latt seg inspirere av psykologien, og forklarer hvordan psykologien og sykepleieteoriene henger sammen. Noen av temaene hun behandler, er helheten kropp og sjel, følelser, hukommelsen og det meningsskapende i tilværelsen. Videre skriver hun om mellommenneskelige prosesser som relasjoner, kommunikasjon og medfølelse. Sykepleierens helsefremmende arbeid og psykologiske aspekter på god og dårlig helse beskrives også, og leseren får råd om veiledning, informasjonsarbeid, problem- og konfliktløsning.

    Sykepleierens grunnlagsverdier er bokens røde tråd. Hovedformålet med boken er å gi leseren bedre innsikt i hvordan mennesker fungerer på et psykologisk plan, og vise hvordan denne innsikten kan være med og danne grunnlag for de vurderingene en sykepleier må gjøre daglig i sitt virke.Målgruppen er først og fremst bachelorstudenter i sykepleie, men boken vil også være nyttig for andre helsefagstudenter og yrkesaktive sykepleiere.

  • Self-compassion and narrative identity : (keynote presentation)
  • Getting to know the person behind the illness - the significance of interacting with patients hospitalised in forensic psychiatric settings

    Aims and objectives: To describe what nurses want to accomplish in relationships with patients who are hospitalised in forensic psychiatric settings. Background: Relationships between staff and patients in forensic psychiatric settings should be grounded in trust and confidence, and the patients need opportunities for emotional reconciliation. However, relationships can be challenging for nurses, who sometimes distance themselves from patients' expressions of suffering. The role of forensic mental health nurses is nebulous, as are the prescriptives and the implementation of nursing practices. Design: Qualitative descriptive design. Methods: In-depth interviews with five nurses who all work in forensic psychiatric settings. Results: We present a descriptive analysis of what nurses want to accomplish in relationships with patients who are hospitalised in forensic psychiatric settings. The results are presented in two main categories: (1) getting to know the person behind the illness and (2) making a difference. Conclusion: Care in forensic psychiatry needs to shift towards a more long-term view of the role of nursing, focusing less on the traditional and stereotypical identity of the productive nurse and more on the care given when nurses slow down and take the time to see the patients as individuals. Establishing trusting relationships with patients in forensic psychiatric settings is viewed as a less oppressive way to control patients and guide them in directions that are preferable for the nurses and for the society. Relevance to clinical practice: Nurses may use simple strategies in their daily practice such as sitting on the sofa with patients to establish trust. We stress that nurses should abandon policing roles and custodial activities in favour of guiding principles that promote individual recovery, treatment and health-promoting care.

  • Philosophical Grounding in a Reflective Lifeworld Research Approach : Where Is the Place for Description vs. Interpretation?
  • Co-creation of Narrative Data : An Ethical and Methodological Challenge

    In qualitative research articles, different approaches to narrative analysis are frequently described. Even though methods for collecting data are described, less focus has been put on narrative data from an epistemological point of view. However, as humans, we live in a storied world. To narrate is a way to create meaning by organizing and structuring events, and the narrative is also considered to have an identity-creating nature. This has implications for research not only for how we represent the world in our research but also for how we understand the interaction between interviewer and interviewee. Hence, narration cannot be reduced to the transformation of data from the participant to the researcher. Rather narration must be understood as a way to relate to another human being. In this presentation, I will take my point of departure in narration as an aspect of self-understanding, and the ethical and methodological challenges associated with the dialogical relationship between the researcher and the participant. Influenced by Paul Ricoeur’s philosophy as well as theories about caring conversation I will reflect on the significance of concepts like autonomy, mutuality, asymmetry, and presence in relation to narrative research. This reflection will provide basis not only for ethical reflections but also for methodological considerations concerning trustworthiness and narrative truth.

  • The multifacetted vigilance - nurses’ experiences of caring encounters with patients suffering from substance use disorder

    Background

    Nursing care is guided by a value base focusing on promoting dignity and health by means of the caring relationship. However, previous research has revealed that negative attitudes towards ‘addicted’ patients, as well as these patients’ behaviour, can give rise to negative emotions such as frustration and disappointment among nurses. This can contribute to a judgmental and controlling attitude towards patients. To preserve order, nursing interventions focusing on creating structure and stability could be applied in a way that challenges caring values.

    Aims and objectives

    This study aimed to describe how nurses’ working in inpatient psychiatric care experience caring encounters with patients suffering from substance use disorder (SUD).

    Design

    This qualitative study is part of a clinical application project focusing on value-based care of patients suffering from SUD. Data were obtained during four reflective group dialogues with six nurses in a psychiatric hospital.

    Methods

    The transcribed dialogues were subjected to latent qualitative content analysis.

    Results

    The analysis facilitated the organisation of the findings into a coherent pattern. A common thread of meaning was conceptualised as a theme labelled ‘the multifaceted vigilance’, describing how nurses strived to deliver good care, while at the same time being vigilant towards patients’ behaviour as well as their own reactions to it. Within that theme, four categories described experiences related to different challenges nurses face in caring encounters.

    Conclusion

    We suggest that this perhaps unavoidable aspect of caring encounters can be an asset. Thus, if acknowledged and subject to reflection, being vigilant could be understood as a strength enabling nurses to safeguard caring values, and to use their authority to promote patients’ health and alleviate suffering.

  • Vårdvetenskapliga begrepp i teori och praktik

    En vetenskap och dess teorier byggs upp av begrepp som på olika sätt relaterar till varandra och beskriver vetenskapens sätt att se på den egna verksamheten. Tillsammans formar begreppen en syn på verkligheten som kan te sig mer eller mindre abstrakt, samtidigt som abstraktionsnivån också bidrar till att teorier kan ha såväl djup som omfång. I den här boken fokuseras begrepp som anses viktiga inom vårdvetenskapen.

    Huvuddelen av boken beskriver begrepp som utvecklats av forskare från Sverige, Finland och Norge. Både övergripande begrepp som exempelvis hälsa och vårdande och mer avgränsade begrepp som vila, vårdande kommunikation och tröst tas upp i boken. I denna andra upplaga har texten utöver några nya begrepp även kompletterats med reflektionsfrågor och övningar.

    Boken vänder sig till studerande i sjuksköterskeprogrammet och olika specialistsjuksköterskeprogram, men passar också andra yrkesgrupper i vårdande verksamheter och de som är intresserade av att förstå mer om vårdvetenskap 
i allmänhet, och om dess begrepp och språkanvändning i synnerhet

  • Medlidande och 'compassion'
  • Förståelse och personcentrerad vård inom psykiatrisk omvårdnad
  • Själ
  • To be present, share and nurture : a lifeworld phenomenological study of relatives' participation in the suicidal person's recovery

    In today's health care, participation is acknowledged as important. However, there is limited research on how relatives of patients at risk of suicide experience their opportunities to participate in care during periods when their close ones are subject to inpatient care. The aim of this study was to describe the phenomenon of participation, as experienced by relatives of persons who are subject to inpatient psychiatric care due to a risk of suicide. The study was conducted through a reflective lifeworld research (RLR) approach, based on phenomenological philosophy. Eight relatives of patients receiving care from professionals in a psychiatric specialist health care context in Sweden participated in phenomenon-oriented interviews. Data were analysed to elucidate a meaning structure of the phenomenon. The findings show that the phenomenon of participation was more associated with patients' recovery processes than with the caring process, and means "being actively involved in a process in which the person regains the desire to live". The meaning of participation is further described by its meaning constituents: struggling for being able to be present for the person at risk of suicide, being able to share everyday life, and nurturing sources for vitality. These insights into the meaning of participation highlight the importance of allowing supportive relatives to be a part of the patient's life, while the person is cared for in an inpatient hospital setting. Thus, participation enables relatives to be acknowledged as resourceful human beings in the patient's recovery process, and thereby facilitates a sense of being able to manage and share life itself together with the person. This means that mental health nurses need to recognize individual variations of relatives' participation processes, and take on the responsibility of acknowledging relatives' lifeworlds.

  • Compassion for self and others as key aspects of wellbeing in changing times
  • Att möta och bära andras lidande.
  • Reconnecting with oneself while struggling between life and death : The phenomenon of recovery as experienced by persons at risk of suicide

    The body of knowledge regarding health and recovery as experienced by patients at risk of suicide is limited. More research is needed into the meaning of recovery and what strengthens the desire to live. The aim of this study was to describe the phenomenon of recovery in a context of nursing care as experienced by persons at risk of suicide. In line with a reflective lifeworld research approach, 14 patients from a psychiatric clinic in Sweden participated in phenomenon-oriented interviews. Data were analyzed to describe the essence of the phenomenon. The results reveal that the phenomenon of recovery means ‘reconnecting with oneself while struggling between life and death’. Three meaning constituents emerged: being in an expressive space and giving voice to oneself, regaining dignity through nurturing connectedness, and finding a balance in the tension between life and death. In conclusion, the meaning of recovery is to experience the ability to manage one's own life. Professional caregivers need to acknowledge patients' lifeworlds, in a way that enable patients to experience themselves as capable of managing their own lives. Professional caregivers should also facilitate the involvement of supportive relatives.

  • Compassion for self and others as key aspects of well-being in changing times

    Compassion has been put forth as a core concept in caring science, although there has also been a debate over whether it is a nonprofessional sentiment or not. In this theoretical article, I reflect on compassion not only for others but also for oneself as being important for patients' as well as professionals' well-being. My reflections on compassion as being essential in caring are grounded not only in caring science but also in research from other disciplines, as a means of exploring why we need compassion in caring from different perspectives. My conclusion is that in changing times, where patients as well as caregivers are confronted with challenges in life, compassion for self as well as others must be acknowledged as pivotal in relation to well-being and care

  • Hermeneutic Inquiry : Researching Lived Experience of Mental Health and Recovery in a Christian Monastery in Contemporary Sweden

    In this case study, we, the student Nadya and her supervisor Lena, will describe the processand challenges associated with conducting an empirical study for a master’s degree in caringscience in psychiatric nursing. We will describe how the idea for the thesis evolved, theoreticaland practical preparations, as well as methodological procedures in relation to data collectionand analysis. We will also share some reflections we made in relation to challengesencountered during this study. Many of these reflections were directed toward methodologicalaspects of the study. However, along the way, it also became clear that experiences fromconducting the study also yielded important knowledge and understanding about mental healthcare. The reflections about what happened in the encounter between Nadya and theparticipants added depth not only to our understanding of the subject for this study, that is,how mental health, care, and recovery are experienced by people in a Christian monastery incontemporary Sweden, but also shed light on important aspects of mental health nursing inrelation to modern psychiatry.

  • A sanctuary of safety : A study of how patients with dual diagnosis experience caring conversations

    The prevalence of dual diagnosis, that is, the combination of psychiatric illnesses and substance use disorders, is high. As a vast majority of previous research in this context focusses on the effects of different treatment methods, rather than interpersonal issues, the purpose of the present study was to explore and illuminate in what way patients with a dual diagnosis experience conversations with nurses in an outpatient clinic to be caring. Five patients were interviewed regarding their experiences of caring conversations. The analysis and interpretation were inspired by a previously-used hermeneutical process. These yielded three themes: (i) reciprocity creates safety and communion; (ii) suffering is made visible and understandable; and (iii) self-esteem is restored. When synthesized, these themes gave rise to a main theme - a sanctuary of safety - where suffering is alleviated and dignity and self-esteem are restored. It is concluded that the caring conversation contributes to experiences of safeness. In this specific context, safety appears to be more fundamental than trust for patients' recoveries. The caring conversation also contributes to recovery, as it supports the individual's learning and understanding as a way to cope with problems, which also enables patients to make informed decisions about their own care. The caring conversation contributes to the alleviation of suffering and restoration of dignity and self-esteem for patients with a dual diagnosis. However, there is a need for further research focussing on how the caring conversation can contribute to psychiatric nurses' caring expertise

  • Being mindful as a phenomenological attitude

    Purpose: The purpose of this article is to reflect on being mindful as a phenomenological attitude rather than on describing mindfulness as a therapeutic intervention. I will also explore the possibilities that being mindful might open up in relation to nursing research and holistic nursing. Design and Method: I will describe and interpret mindfulness as a state of being by means of van Manen’s phenomenological method, using the language of phenomenology rather than the language of reductionist science. Thus, this article can be considered a reflective narrative, describing both the process of orienting to the phenomenon, making preunderstandings—including own experiences of mindfulness—visible, and a thematic analysis of nine scientific articles describing the phenomenon. Findings: Being mindful as a phenomenological attitude can be described as a deliberate intentionality, where the person is present in the moment and open to what is going on, bridling personal values and accepting the unfamiliar, thus achieving a sense of being peacefully situated in the world, and able to apprehend one’s being-in-the-world. Conclusions: Being mindful as a phenomenological attitude can contribute not only to phenomenological nursing research but also support nurses’ presence and awareness

  • Caring for the suicidal person : A Delphi study of what characterizes a recovery-oriented caring approach

    More research is needed for supporting mental health nurses in their caring for suicidal individuals. This study aimed to describe what characterizes a recovery‐oriented caring approach, and how this can be expressed through caring acts involving suicidal patients and their relatives. Delphi methodology was used, and research participants were recruited as experts by experience to explore a recovery‐oriented caring approach in a dialogical process between the experts and the researchers. The results highlight that it is important to acknowledge the view of the uniqueness of each person and reflected understanding of each individual person and experience. The results also reveal that a recovery‐oriented caring approach is characterized by a ‘communicative togetherness’. This communicative togetherness is associated with enabling a nurturing and caring space for suicidal patients to really express themselves and to reach for their own resources. The recovery‐oriented caring approach has thereby potential to facilitate a mutual understanding of the complexities of the patient's situation, and supports patients in influencing their care and regaining authority over their own lives. Accordingly, mental health nurses need to listen sensitively to what suicidal patients really say by acknowledging their lifeworlds and being open to individual variations of their recovery processes. This includes recognizing available and supportive relatives as capable of contributing to the patient's life project to continue living.

  • Handledning : - att stödja andras professionella utveckling
  • Omvårdnad vid psykisk ohälsa - på grundnivå

    Boken presenterar översiktlig kunskap om psykisk ohälsa,psykiatriska sjukdomar och individers problematik rörande psykisk ohälsa. Den första delen fokuserar på den mest förekommande ohälsan inom psykiatrisk vård. Den senare delen belyser viktiga områden som har betydelse för hur vården kring patienten kan förstås och hanteras, såsom vårdens miljö och organisation, attityder kring psykiska dilemman, närståendes medverkan och kvalitetsarbete inom psykiatrisk vård. I denna tredje upplaga har tidigare kapitel uppdateras med ny forskning,och utvecklats med tanke på att sjuksköterskor träffar personer som lider av psykisk ohälsa också i andra former av vård än inom den psykiatriska vården. Dessutom har några nya kapitel tillkommit som belyser barns övergång från barnpsykiatrisk vård till vuxen psykiatrisk vård och våld i nära relationer. Ytterligare två kapitel finns med som fokuserar på interaktioner och reflektioner kring vård av personer inom psykiatrisk heldygnsvård.

    I fokus står den unga, den vuxna och den äldre individen och dennes problematik. Utgångspunkten är ett omvårdnadsperspektiv med hänvisningar till omgivande områden såsom medicin,sociologi, farmakologi och psykologi. Det genomgående perspektivet är omvårdnad vid psykisk ohälsa, även om de konkreta åtgärder som beskrivs också kan inspirera och vägleda andra professioner i deras hälsoarbete.

    Boken vänder sig främst till studenter i grundutbildningen till sjuksköterska, men den kan också med fördel användas inom utbildningar med inriktning mot folkhälsa samt av kliniskt verksamma sjuksköterskor inom kommunal vård och primär- eller specialistvård.

    Omvårdnad vid psykisk ohälsa – på grundnivå omfattar också en digital del. Vid sidan av den digitala versionen av boken finns material som underlättar studierna i form av kapitelsammanfattningar, övningar och sluttest.

  • Stress, utbrändhet och utmattningssyndrom
  • Vårdande vid psykisk ohälsa - på avancerad nivå

    Boken ger läsaren en grund för ett personcentrerat och återhämtningsinriktat vårdande genom att ta fasta på vårdvetenskaplig forskning som beaktar patientens och närståendes livsvärld.

    Återhämtning som en pågående process där personen formar sitt liv utgående från sina egna förutsättningar och värden löper som en röd tråd genom boken. Teman som exempelvis sorg, hopplöshet och utanförskap beskrivs i relation till psykisk ohälsa och återhämtning. Boken tar även fasta på hur personens egen kompetens kan tas till vara för att främja hälsa och återhämtning.Vårdarens hållning lyfts fram i relation till patientens hälsoprocesser och med fokus på vårdkulturen, vårdande relationer och kommunikation mellan vårdare, patienter och deras närstående.

    I denna tredje upplaga av boken har de tidigare kapitlen omarbetats och uppdaterats med ny forskning och flera kapitel har tillkommit. Bland de nya kapitlen återfinns ett kapitel om en omvårdnadsteori utvecklad för psykiatrisk vård,Tidvattenmodellen, skrivet av Phil Barker och Poppy Buchanan-Barker samt ett kapitel av de norska forskarna Bengt Karlsson och Marit Borg. Andra nyheter berör existentiella samtal och återhämtningsinriktade samtal med suicidnära patienter, samt barn och ungdomars psykiska ohälsa. Boken har också kompletterats med flera kapitel som fokuserar ett reflekterande arbetssätt och hur specialistsjuksköterskans kärnkompetenser kan komma till uttryck inom personcentrerad och återhämtningsinriktad psykiatrisk vård.

    Målgruppen är i första hand studenter på avancerad nivå samt sjuksköterskor inom den psykiatriska vården. Boken kan emellertid också vara läsvärd för andra som är intresserade av att få en inblick i hur den psykiatriska vården kan förstås med utgångspunkt i patientens värld och ett caring-perspektiv, snarare än utgående från diagnostiska kriterier.

  • Att utbilda sig till specialistsjuksköterska inom psykiatrisk vård
  • Att integrera teori och praktik i personcentrerad vård
  • Att evidensbasera och utveckla psykiatrisk omvårdnad
  • Ledarskap och teamarbete