SAMMANFATTNING Syftet med denna studie var att ta reda på vad sjuksköterskan upplever som sitt inre etiska ansvar samt lyfta fram och reflektera över den etiska dimensionen i omvårdnaden. Studien är empirisk och grundar sig på en kvalitativ metod med innehållsanalys. Data har samlats in från fyra intervjuade verksamma allmänsjuksköterskor. Forskningen anknyter till Katie Erikssons omvårdnadsteori samt till Iréne von Post. Etiken hos de intervjuade sjuksköterskorna förknippades till stor del utifrån ett medicinskt perspektiv. Resultatet pekade dock på att sjuksköterskan till viss del handlar utifrån sitt inre etiska ansvar i den dagliga omvårdnaden såsom den teoretiska ansatsen beskriver. Ett reflekterande förhållningssätt medvetandegör den etiska dimensionen i omvårdnaden. Ansvar i omvårdnaden ansågs vara att tillgodose varje patients individuella behov. Emellertid påvisade resultatet vissa hinder och förutsättningar för en god omvårdnad. Mod framkom som en betydande egenskap hos sjuksköterskan eftersom det upplevdes ett behov av att försvara sitt ansvarsområde-omvårdnaden. ABSTRACT The aim of this subject is to find out how the nurse meets with her inner ethical responsibilities and to bring forward and consider the ethical dimension of caring. The study is empirical and has its base in a qualitative method with an analysis of content. Data has been gathered from four practising hospital nurses. The research connects on to Katie Eriksson?s theory of caring and to Iréne von Post. The ethics of the nurses interviewed is to a large content seen from a medical point of view. Yet, the result points to the fact that the nurse partly acts from her inner ethical responsibility in daily care, as the theoretical suggestion describes. A reflective attitude raises the level of consciousness of the ethical dimension in health care. It is considered that the responsibility of nursing is to be able to meet the need in every single patient. However, the result showed some hinders and necessary qualities for good health care. Courage is one important trait among nurses, as they feel a need to be able to stand up for their field of responsibility, namely caring.

The aim of this study was to review literature on how the lived experience of breast cancer and suffering was described in nursing/caring literature between 1990 and 2000, and to interpret and discuss the result from the perspective of suffering. The frequent reports of changing courses, called by various names, such as transition, transformation, transcendence, and finding meaning, werefound as paths whereby the person regained integrity, balance, and wholeness. When findings were interpreted from the perspective of suffering and an ontological health model, actions, values, and existential concerns were understood as both expedients for alleviating suffering and a sign of the patient's inner struggle.

In this study, qualitative content analysis was used in order to understand the reported changes of life perspective in interviews with 59 women with breast cancer who were admitted to complementary care. The aim of this research was to study women's perceived consequences as well as perceived causes of breast cancer and to explore aspects of importance to the women. The material was collected in semistructured interviews from women with breast cancer at different stages of the disease. The women received complementary care at an anthroposophic clinic in Sweden. Findings showed that these women's view of their relationships with others grew more valuable. Their self-confidence and experience of strength improved, and they regarded life as being more enriched. A change in their disposition towards becoming more fragile and low-spirited was experienced as a hardship by the women. Am interesting finding was that the patients described the aetiology of the disease from several interacting perspectives, which also affected their ideas of how to achieve wellbeing and health. The findings support the view that changes of both benefit and harm are present in the experience of breast cancer.

Barns tankar om döden är olika beroende på deras mognadsnivå. I arbetet har familjen betraktats som kontext och det cancersjuka barnet som klient i sjuksköterskans bemötande av svåra frågor om döden. Syftet var att beskriva sjuksköterskans kliniska erfarenheter som kan vara vägledande vid bemötande av cancersjuka barns frågor om döendet och döden. Frågeställningarna var "Vilka förutsättningar påverkar sjuksköterskans möjlighet att tala med barn om döden?", ?Hur bemöter sjuksköterskan barnets frågor om döendet/döden?? och "Hur utvecklas sjuksköterskan i sin yrkesroll i omvårdnaden av cancersjuka barn?" Vi använde oss av litteraturgranskning som metod p.g.a. begränsat antal verksamma sjuksköterskor inom barnonkologi i Blekinge. Studien grundade sig mestadels på kvalitativa ansatser. I resultatet framkom att observationer av barn på onkologiavdelningar visade att öppen och tydlig kommunikation är viktigt vid bemötande av frågor om döden som tas upp av barnet själv. Det finns ett flertal specifika strategier som kan vara till hjälp vid bemötandet. Medvetenhet om vård av cancersjuka barn erhålls av sjuksköterskan genom en anpassningsprocess. Att sjuksköterskan förklarar död och sjukdom öppet, direkt och sanningsenligt utan omskrivningar tror vi är en väldigt viktig del i omhändertagandet av ett cancersjukt barn som har funderingar om döden. Vi anser att det är av betydelse att som sjuksköterskor lära oss att vi inte har några definitiva svar att ge barnen, vi kan inte heller lära oss att ge de exakt rätta svaren. Konsten är att våga samtala, våga möta barnens frågor.

SAMMANFATTNING En av sjuksköterskans dagliga omvårdnadsåtgärder är att lägga in och ansvara för patientens omvårdnad i samband med perifer venkanyl. Studiens syfte har varit att undersöka hur handläggningen och bristerna beskrivs i samband med att patienten erhåller en perifer venkanyl, samt att ge ett förslag hur vårdprocessen som modell kan motverka brister i den kliniska handläggningen av perifer venkanyl. Undersökningen har genomförts som en litteraturstudie där resultatet grundar sig på vetenskapliga artiklar och två böcker inom området. En kombination av Eriksson och Atkinson & Murrays vårdprocessmodeller har använts som utgångspunkt i studien. Deras modeller bygger på fyra faser och kan tillämpas i alla vård situationer. Resultatet visade på flera brister i den kliniska handläggningen av perifer venkanyl. Vid handläggning av venkanyler var 52 procent otillfredsställande. När sjuksköterskan har genomfört de fyra faserna bör patienten ha uppnått slutmålet; optimal hälsa. Vårdpersonalen måste besitta kunskaper om vad som påverkar uppkomsten av komplikationer hos patienten med perifer venkanyl.

Background. Persistent pain is a common problem for older people. Knowledge about how nursing and paramedical staff perceive these people and what they do to relieve the pain seems scarce. Aim. To explore nursing and paramedical staff perceptions of older people in persistent pain and their day-to-day management of pain. Methods. Interviews in Swedish with 52 nursing auxiliaries, Registered Nurses, physiotherapists and occupational therapists were collected from February to May 2000. The analysis was based on their stories (n = 150) about older people in persistent pain who received help in their own homes or in special accommodation. A typology of staff perceptions of pain in older people was developed. Activities to manage pain were examined using content analysis. Results. Respondents perceived the pain as real, exaggerated, trivial, care-related, endured, concealed, self-caused or inarticulate. Older people perceived as exaggerating the pain, those with care-related and self-caused pain evoked frustration in the staff, while those perceived as enduring their pain evoked satisfaction. Various strategies to manage pain were used: no activity, medication, mediating contacts, distracting activities, physical therapies, mobility, work in a gentle way, rest or relieving pressure on body part, and communication concerning pain. The activities differed between the types, as well as between staff with different professional backgrounds. Conclusion. Care and treatment provided by staff should be based on older people's needs rather than on staff attitudes and preferences. The typology revealed that staff perceived older people in pain as a heterogeneous group and that their perceptions affected the pain-relieving activities that were offered. It seems urgent to address how to handle pain in older people who never complain and those who complain a great deal, as well as how to handle pain in people with impaired communicative ability. Reflective discussions on feelings related to different individuals are needed.

Background. Although the topic of pain among older people has received increasing interest, little is still known about how pain is experienced or handled by those who no longer manage independently but depend on professionals for help with daily living. Developing pain management for older people requires such knowledge. Aim. To explore sense of self, sense of pain, daily living with pain, sense of others and ways of handling pain in older people with persistent pain. Methods. Interviews with 90 older people receiving home care from nursing auxiliaries in their own homes or in sheltered accommodation were collected from January to June 2000. A typology of older people in persistent pain was developed. Activities for handling pain were examined using content analysis. Findings. Respondents' experiences of themselves and their pain varied. Two groups of older people, considered as 'competent and proud' and 'confident and serene', expressed satisfaction in spite of pain, while the groups 'misunderstood and disappointed' and 'resigned and sad' expressed dissatisfaction. The most common strategies used were medication, rest, mobility, distracting activities and talking about pain. Respondents chose strategies by balancing the advantages of the activities against the disadvantages these brought for their daily living. Conclusion. This study indicates that characteristics of the older people, such as their way of experiencing themselves, how pain affects their daily life and how they perceive effects and side-effects of pain management are areas that need to be identified when staff assess pain and plan pain management. Caring for older people in pain could be improved by listening to and believing their complaints, evaluating effects and side-effects from medications and nonpharmacological pain management and by emphasising the importance of common everyday activities such as mobility and distraction to relieve pain.

Pain is a common problem for older persons who need professional help for their daily living. In this study 94 older persons (75+) in persistent pain were compared with 52 care providers concerning the pain management methods they had used/administered during the previous week and how helpful they perceived these methods to be. interviews were based on 16 items from the original version of the pain management inventory (PMI). Both groups perceived prescribed medication, rest and distraction as the most frequently utilized methods. Specific methods such as transcutaneous electrical nerve stimulation (TENS) or bracing/splinting or bandaging the affected body part were seldom employed, although most users perceived these methods as helpful. Care providers perceived most methods for managing pain as more effective than older persons did. The results imply that care providers need skills in a variety of pharmacological and nonpharmacological methods to manage pain and a need to evaluate effectiveness of the methods in a systematic way.

Sammanfattning Bristen på omvårdnadsforskning gällande anorexia nervosa är stor, det är därför viktigt att denna sjukdom uppmärksammas mer. Studiens syfte har varit att belysa hur kvinnor med anorexia nervosa beskriver livskvalitet under sjukdomstiden. Studien har genomförts som en litteraturstudie där resultatet bygger på tre skönlitterära böcker som kvinnorna själva skrivit. Som teoretisk referensram har Lawtons definition på livskvalitet används då denna definition stämmer överens med författarnas syn på begreppet livskvalitet. Resultatet uppmärksammade följande kategorier som viktiga för kvinnornas livskvalitet; längtan efter närhet, den dyrbara fritiden, störd autonomi och brist på empati, kamp om renhet, omgivningens brist på förståelse, flykt från verkligheten, trygghet genom sjukdomen, samt sjukdomsinsikt. I diskussionen framkom att vårdpersonalens bemötande av anorexia nervosa patienterna spelade en viktig roll under sjukhusvistelsen, gällande upplevd livskvalitet.

Det krävs mycket av en sjuksköterska för att kunna skapa tillit och förtroende prehospitalt med en skadad person. Syftet har varit att undersöka vilka faktorer/åtgärder/förhållningssätt som krävs av en sjuksköterska i första mötet med en skadad person för att skapa en förtroendefull och kontakt med känsla av tillit. Undersökningen har genomförts som en litteraturstudie och resultatet visar på att om en förtroendefull kontakt ska skapas mellan sjuksköterskan och en skadad person prehospitalt krävs det framför allt att en kommunikation dem emellan kommer till stånd. Andra slutsatser i resultatet är att en sjuksköterska måste utföra vissa kommunikationsstrategier för att en kontakt ska uppstå. De kommunikationsstrategier som är väsentliga för att skapa en förtroendefull kontakt är bland andra sjuksköterskans förhållningssätt samt att sjuksköterskan har självinsikt och kunskap om effekter av ett sitt agerande. Slutsatsen blev att sjuksköterskan bör känna till sitt eget samt sin patients kroppsspråk så att missförstånd i kontakten undvikes. Sjuksköterskan bör känna empati och kunna avgöra när han gör intrång i patientens privata utrymme. Sjuksköterskan ska därför vara noga med att röra vid patienten med eftertanke. Det är även av stor vikt att sjuksköterskan informerar patienten om läget/ situationen och förklarar vad som sker för att tillit och förtroende ska kunna skapas.

The aim was to illuminate elderly persons' experiences of living with venous leg ulcer. Fifteen persons 74-89 years of age with active leg ulcer were interviewed. Data were analysed utilizing a phenomenological-hermeneutic approach inspired by Ricoeur. The analysis includes dialectic movement between understanding and explanation of the text as a whole and its parts, In the structural analysis four themes were identified: emotional consequences of altered body image, living a restricted life, achievement of well-being in connection with a painful wound and bandage, and struggle between hope and despair with regard to a lengthy healing process. The comprehensive understanding indicated that the meaning of living with venous leg ulcer can be understood as a dialectal relationship between, on the one hand the feeling of being imprisoned in the body, the bandage and the home, and on the other hand, hope of freedom from a burdensome body. The results indicate that the concept, body of image, is vitally relevant to the caring, of elderly people with venous leg ulcer. The study shows the importance of recognizing the persons' perceptions of their leg ulcers and the impact of these perceptions on well-being. Nurses can thereby anticipate problems and provide more sensitive care.

In year 2000 6 348 women were diagnosed with breast cancer, breast cancer is thereby the most common form of cancer among women. People who are diagnosed with cancer experience great existentiell changes, uncertainty and loneliness. The aim of this study was to describe the breast cancerpatients experiences from the nursing encounter. This study is a litterature study and the authors have used Polit & Hunglers modell. The findings showed that the womens experiences were both positive and negative from the nursing encount. The findings were sorted into four different themes: the nurses treatment, accessibility, the nurses competance and communication ? information. Depending on how the women experienced the nursing encounter it resulted in wellbeing or suffering. Positive experiences increased the womens wellbeing and negative experiences caused suffering. Still none of the women were left uneffected after the nursing encounter. The findings showed that the nurses treatment of the patients were of vital importance for how the women managed their illness and their situation. Whether the women were afraid, in denial or accepted the situation also effected the nursing encounter.

Research on immigrant health emphasizes that the elderly are more vulnerable than other age groups in many immigrant populations. This study describes the meanings of health, illness, and disease for Iranian elderly immigrants in Sweden and their relationships with life disruptions. Analysis of interviews using an interprerive-phenomenological method illustrates that the participants experience health as continuity and balance in life. Any disruption of this balance creates a sense of illness that is only partially related to the emergence of disease. Participants did nor view health and disease as polarized. Rather disease is just one component among many that may disrupt the experience of health. Health is perceived as a sense of well-being, can be achieved in spite of disease, and can be disrupted even in the absence of disease. This description of the meaning of health, disease, and illness contrasts with the Western biomedical perspective and is similar in its holism to various non-Western medical systems and complementary approaches. This knowledge can foster more culturally sensitive care.

Late-in-life immigrants are often at risk for psychological stress and social isolation because of language problems, small social networks, and cultural differences from the host society. Community intervention programs can reduce such stress and isolation. In this article, the authors describe a Swedish municipality's culturally appropriate intervention program for elderly Iranian immigrants based on ethnographic data gathered during a 12 month period The description includes the activities provided by the program and the experiences of the elderly Iranian immigrants who participate regularly in these activities. The findings document the positive impact of regular participation in the center's activities on the elders' well-being and health.

The local expressions of a Lagrangian half-form on a quantized Lagrangian submanifold of phase space are the wavefunctions of quantum mechanics. We show that one recovers Maslov's asymptotic formula for the solutions to Schrodinger's equation if one transports these half-forms by the flow associated with a Hamiltonian H. We then consider the case when the Hamiltonian flow is replaced by the flow associated with the Bohmian, and are led to the conclusion that the use of Lagrangian half-forms leads to a quantum mechanics on phase space. (C) Elsevier, Paris.

The notion of phase plays an essential role in both semiclassical and quantum mechanics. But what is exactly a phase, and how does it change with time? It turns out that the most universal definition of a phase can be given in terms of Lagrangian manifolds by exploiting the properties of the Poincare-Cartan form. Such a phase is defined, not in configuration space, but rather in phase-space and is thus insensitive to the appearance of caustics. Surprisingly enough, this approach allows us to recover the Heisenberg-Weyl formalism without invoking commutation relations for observables.

We replace the usual heuristic notion of quantum cell by that of 'quantum blob', which does not depend on the dimension of phase space. Quantum blobs, which are defined in terms of symplectic capacities, are canonical invariants. They allow us to prove an exact uncertainty principle for semiclassically quantized Hamiltonian systems. (C) 2003 Elsevier B.V. All rights reserved.

We propose a definition of quantum cells which is invariant under symplectic transformations. We use this notion to the study of positivity properties of the Wigner and Husimi functions, which allows us to precise and to improve known results. © 2004 Elsevier SAS. Tous droits réservés.

22 : The cohomological interpretation of the indices of Robbin and Salamon, (with S. de Gosson), Jean Leray ´99 Conference Proceedings, Math. Phys. Studies 4, Kluwer Academic Press, 2003

We show, using the symplectically invariant notion of 'quantum blob', that it is possible to attach a canonical optimal Gaussian pure state to an arbitrary quantum state. When at least one pair of conjugate variables satisfies the minimum uncertainty condition, then the associated Gaussian is uniquely determined up to an overall phase factor. (C) 2004 Elsevier B.V. All rights reserved

we study the Maslov index of the monodromy matrix of periodic Hamiltonian orbit, extending substantially results of other authors

Caregiver singing and background music were incorporated into the interaction between caregiver and patient, the aim being to illuminate the meaning of verbal communication between persons with severe dementia and their caregivers. In the absence of music, patients communicated with cognitive and behavioral symptoms associated with dementia. In these situations, caregivers devoted their verbal communication to narrating and explaining their caring activities to the patient. The patient and caregiver. however had difficulties understanding one another. In the presence of background music, caregivers decreased their verbal instructing rind narrating while the patient communicated with an increased understanding of the situation, both verbally and behaviorally. During caregiver singing, a paradoxical effect was observed such that despite an evident reduction in the amount of verbal narration and description by the caregiver. the patient implicitly understood what was happening.

Background and Aim: Previous research suggested caregiver singing could influence persons with severe dementia to communicate with increased competence, to cease aggression, and to cease disruptive screaming, while at the same time they seemed to understand what was going on when being cared for during morning care sessions. The aim of this study was to illuminate the posture, body movements, and sensory awareness of patients with dementia during three types of morning care sessions with professional caregivers: (a) the usual morning care situation, (b) a caring session in which familiar background music was played, and (c) a caring session in which the caregiver sang to and/or with the patient throughout. Nine patients with late-stage dementia and 5 professional caregivers participated in this study, and 27 sessions were videotaped (9 patients x 3 caring situations). Data Collection and Method: Data collection was done by means of video recording and the data were analyzed using qualitative content analysis. Results: During the usual caring situation, patients demonstrated slumped posture, sluggish and asymmetric motion, listlessness, minimal awareness of both egocentric space and the physical environment, and a poor ability to perform to completion activities necessary for personal care. Both background music playing and caregiver singing had strong influences on the body and on sensory awareness. Patients had straightened posture, stronger and more symmetric movements, and a greatly increased awareness of themselves and their environment. Patients appeared to regain skills necessary for daily living, and demonstrated that they could perform tasks with intention, purpose, and competence. Caregiver singing, in particular, was very effective at drawing out capabilities that appeared to be lost in these patients. In addition, caregiver singing elicited a larger degree of mutuality in the interaction between patient and caregiver than was seen with background music. Discussion: These results provide further support for the use of caregiver singing in dementia care, and the findings on how caregiver singing can be used to help in dementia caring situations are discussed.

Syftet med denna litteraturstudie är att belysa omvårdnaden för familjer till barn med hjärtfel ur ett familjeperspektiv. Vården av hjärtsjuka barn och ungdomar kräver en kunskap om dessa sjukdomar inte enbart hos sjukvårdspersonal inom den högspecialiserade barnkardiologin utan inom ett flertal andra specialiteter. Studien omfattar sjuksköterskans omvårdnad av familjer, förberedelser för hemgång, samarbetet mellan olika yrkeskategorier, familjens reaktioner vid denna krissituation och de bearbetningsmodeller som finns till förfogande för att underlätta bearbetningsprocessen. Vidare forskning inom detta område är nödvändig. The purpose of this study is to illuminate the care of families to children with heartdisease from a familyperspective. Care of heart diseased children and adolocents demands a knowledge about these diseases not entirely among nursing staff within the specialized cardilogi of children besides in several other specialities. The study includes nurses care of families, preparation for homecare, coloboration between different professional categories, families reactions at a critical situation and the adaption models that is available to facilitate adaptionprocess. Further research in this area is needed.

Nurse-patient cooperation during morning care in two wards for the care of severely demented patients (107 observations) were analyzed by using a hermeneutic-phenomenological approach. Nurse-patient cooperation was found to be characterized by their acting in mutuality or unilaterality and in or out of pace with each other. When acting in pace and mutuality, the nurse and patient turned to each other as persons as well as to the task. This theme related to confirming nurse actions and actions that provided opportunities for the patient to participate. When acting out of pace and unilaterality, cooperation was mainly task oriented and related to acts of resistance, the use of force, loss of attention or turning to others, or the patient wanted to escape. The findings were interpreted within the contexts of power, empowerment, and powerlessness and may serve as indicators of low- or high-quality nurse-patient cooperation during morning care provided for demented patients.

syftet med studien var att beskriva faktorer som har betydelse vid interaktiva kommunikativa omvårdnadshandlingar vid rehabilitering avseende patienter som har afasi/dysfasi.

Family members do not give up their involvement in the life of their older relatives when they move to an institution. Relatives feel that it is they who take the initiative to establish a working relationship with the staff at the nursing home. Relatives want more spontaneous information from staff, particularly about residents' dairy fives, and there is a need for relatives to have opportunities to talk with staff under relaxed conditions. Staff behaviour and activities towards residents and relatives are a source of many feelings for relatives. Relatives' understandings of the challenges faced by staff are not communicated to staff, nor are positive or negative experiences explicitly passed on to staff.

Living with dementia means struggling to preserve a sense of self, to retain (and reevaluate) one's values in a new situation, and to search for a new way of life. This study explored the meaning of everyday life as expressed by 11 people suffering from dementia. Data were collected through interviews with people in the early stage of a diagnosed dementia disease. The findings indicate that many people with dementia feel shame, sorrow, and sadness when their life with the disease begins but also indicate prospects of a more manageable life. Since the reaction and adjustment to dementia differs from person to person, professional caregivers need to use a case-specific approach in the provision of care.

SAMMNFATTNING De personer som sjuksköterskan möter ute på sjukhusavdelningar, särskilda boenden och sjukhem är till stor del äldre. Enligt Wasserman (2000) visar mellan 30 och 40 procent av dessa tecken på depression. Att känna till depressionens uttryckssätt och hur man som sjuksköterska genom omvårdnad ska kunna stödja patienten är därför viktigt. I bakgrunden beskrivs allmänna symtom på depression och hur depressionen tar sig uttryck hos äldre. Till detta kommer behandlingsmöjligheter och omvårdnadsaspekter. Syftet är att belysa vad sjuksköterskan kan göra för att upptäcka och stödja äldre deprimerade patienter och metoden för detta har varit en litteratur studie där innehålls analys använts som analysmetod. Resultatet baseras på nio artiklar som visar att sjuksköterskan kan göra mycket för att upptäcka och stödja äldre deprimerade patienter utan att var någon specialist inom området psykiatri.Genom att känna till depressionens uttryck och vara medveten om att depression inte är en del av det normala åldrandet kan man som sjuksköterska göra mycket för att se till att patienten uppmärksammas och får den omvårdnad och det stöd som han/ hon har rätt till.

We present here the necessary and sufficient conditions for linearization of third-order equations by means of point transformations. We show that all third-order equations that are linearizable by point transformations are contained either in the class of equations which are linear in the second-order derivative, or in the class of equations which are quadratic in the second-order derivative. We provide the linearization test for each of these classes and describe the procedure for obtaining the linearizing point transformations as well as the linearized equation.

Diabetes is a chronic disease that so far has affected 120-150 million people all over the world. This number is calculated to be doubled until year 2025 to 300 million people. One of the biggest problem in diabetic care today is that between 1/3 and ¾ of all people with diabetes fail to comply with medical regimen. The purpose with this study was to explore what nurses in Sweden and Norway experience to be the cause of non-compliance and how they work to get the best compliance from their patients. To find the answer to the question a qualitative interview study was performed featuring twelve nurses, six in southern Sweden and six in Östfold, Norway. The interview material was analyzed according to Dorothea Orem?s nursing theory. The results show that the cause for non-compliance is something very complex, all interviews indicated on different factors that can take part. It is never only one factor that is causing the non-compliance, but several.

I dag bedrivs det palliativ vård i stor omfattning på sjukhus. Palliativ vård innebär inte att bota utan att lindra symtom och öka livskvaliteten för patienter med livshotande sjukdom. För de som befann sig i livets slutskede var det av stor vikt att de psykiska, fysiska, sociala, andliga och existentiella behoven tillfredsställdes för att lindra det lidande som uppstått. Syftet med litteraturstudien var att beskriva patienters upplevelser av lidande och lindrat lidande i palliativ vård. Studien byggde på tre avhandlingar som var aktuella, svenska och handlade om palliativ vård utifrån patienters upplevelser. Resultatet visade att lidandet endast kan lindras om patienterna först fann mening med sitt lidande och sitt liv. Ensamhet, tystnad och att inte bli sedd som medmänniska ökade lidandet medan en god kommunikation, närhet, oberoende, andlig och existentiell tillfredställelse skapade lindrat lidande. När man jobbar inom vården var kunskap om hur patienter upplevde välbefinnande och livskvalitet i livets slut av stor betydelse för att kunna ge tillfredsställande vård till patienterna. Ingen ska behöva lida i onödan och alla bör få möjlighet till en fridfull död. Lidande är en del av livet och alla kommer någon gång i livet att drabbas av lidande.

SAMMANFATTNING Att möta och vårda personer som är allvarligt sjuka och döende är svårt. Syftet med studien var att belysa på vilket sätt som sjuksköterskan kan förmedla empati till en patient i livets slutskede samt att beskriva hur den empatiska relationen kan förstås med hjälp av Joyce Travelbees omvårdnadsteori. Studien är litteraturbaserad och bygger på engelskspråkiga artiklar publicerade i vetenskapliga tidskrifter. Studien bygger på sex vetenskapliga artiklar publicerade mellan 1997 och 2000, varav fem är kvalitativa studier och en är litteraturstudie. I resultatet framkom att en god relation mellan sjuksköterska och patient är av betydelse för en empatisk relation, samt olika kommunikationsvägar och socialt samspel för att få patienten att uppleva livskvalitet. Empati förmedlas genom att hjälpa patienten att få uppleva livskvalité. Detta kan uppnås på olika sätt, bland annat genom att ge tillgänglighet och kontinuitet från sjuksköterskan vilket då kan resultera i en förtroendefull relation mellan parterna.

SAMMANFATTNING Syftet med denna litteraturstudie är att belysa omvårdnaden av familjer som drabbats av plötslig spädbarnsdöd . Omvårdnad av familjen när ett barn dött i plötslig spädbarnsdöd är väldigt viktig för att familjen skall klara av krisen som de har framför sig. För att denna omvårdnad ska bli bra bör olika personalkategorier inom sjukvården ha en bred kunskap om hur familjer upplever den tragedi, de får inte vara rädda för känslor och de bör vara medvetna om de möjligheter som finns att erbjuda familjen i akuta skedet såväl som efter. Studien omfattar hur man tar hand om familjen i det akuta skedet, hur de olika familjemedlemmarna sörjer samt hur familjen reagerar i denna situation. Vidare forskning inom detta området är nödvändig. ABSTRACT The purpose of this study is to illuminate the care of families who lost a child in Sudden infant death syndrome. The care of families when a child dies in SIDS is important how the family will handle the crisis that will come. To make this care as good as possible several specialities among nursing staff needs a wide knowledge about how the family see this experience, they cannot be afraid of the strong feelings that comes with SIDS and they should be aware of the possibilities there is to offer the family, both in the emergency care and in the future. This study includes how to take care of the family in the emergency phase, how the familymembers grief and how they reacts in this kind of situation. Further research in this area is needed.

Purpose: To identify the cognitive processes nurses use in their decision-making in long- and short-term care settings in five countries, and the demographic variables associated with their decision-making. Method and Samples: The instrument used was a 56-item questionnaire that has been shown to be reliable in earlier studies. The sample consisted of five convenience samples of registered nurses working in either geriatric wards (n = 236) or acute medical-surgical wards (n = 223) in hospitals or nursing homes in Canada, Finland, Sweden, Switzerland, and the United States. Findings: Five models of decision-making were identified on the basis of factor analysis. They represent both analytical and intuitive cognitive processes. Analytical cognitive processes were emphasized in information collection, problem definition, and planning of care, and intuitive cognitive processes were emphasized in planning, implementing, and evaluating care. Professional education, practical experience, field of practice, and type of Knowledge were significantly associated with decision-making models as well as with country of residence of the participants, The highest proportion of analytically oriented decisionmakers was found among nurses in long-term care, the decision-making of nurses in shortterm cave was more intuitively oriented. Conclusions: The results indicate that decision-making of participants varied from country to country and in different nursing situations. Future research should be focused on reasons for these differences, the relationship between the task and the nurses' type of knowledge, and how nurses use their knowledge to make decisions in different nursing situations. (C) 2001 SIGMA THETA TAU INTERNATIONAL.

Studiens syfte har varit att se vad sjuksköterskan i sin omvårdnad kan göra för att stödja barn i åldrarna tre till tolv år som är anhöriga till svårt sjuka föräldrar samt i samband med förälderns bortgång. Studien har genomförts som en litteraturstudie. Det har inte direkt forskats så mycket om sjuksköterskans roll vid bemötande av barn som är anhöriga till en svårt sjuk förälder. Den forskning som finns om barn fokuseras till stor del på situationer då det är barnet som är sjukt och föräldrarna är anhöriga. Vissa forskare har dock intresserat sig för stöd av anhöriga i stort. Resultatet av vår studie visar att behovet av stöd finns hos barn och att sjukvårdspersonalen förefaller lämna över ansvaret till föräldrarna. Särskilt påtalas i litteraturen vikten av att uppmuntra föräldrarna till att informera barnet framförallt av förberedande karaktär. Även barns deltagande i förälderns omvårdnad ses som ett viktig stöd för barnet. Det stöd som riktas till barn under den svårt sjukes vårdtid kan även antas ha bety delse för barnet att förbereda sig inför döden och att gå vidare efter dödsfallet utan några fantasier och känsla av skuld, skyldighet. The purpose of this study has been to explore what the nurse can do in her nursing care to support children of the ages 3?12 years who are next of kin to critically ill parents and in the event of the parents death. The study was carried out as a litterature review. There have not been done a lot of direct research on the nurse?s role in treating children who are next of kin to a critically ill parent. The research that has been carried out on children are mainly focused on situations where the child is ill and the parents are next of kin. However some researchers have shown interest in the support of next of kin in general. The result of our study shows that there is a need of support among children and it appears that nursing staff hands the responsibility over to the parents. In the litterature the emphasis is on encouraging parents to inform the child, especially in an preparatory manner. Also a childs participation in the parents nursing care is seen to be an important support of the child. The support d irected toward a child during the critically ills hospitalization could be seen as having a great influence on the child in its preparation for death and on the child moving along after the death without any fantasies and feelings of guilt.

Kroppsberöring är ett viktigt redskap i sjuksköterskans omvårdnadsarbete. Genom kroppsberöring kan trygghet, omtanke, uppmuntran mm åstadkommas. Undersökningens syfte var att utifrån sjuksköterskans perspektiv beskriva kroppsberöringens betydelse i omvårdnadsarbetet, samt att se kroppsberöringen ur ett transkulturellt perspektiv. Författaren valde att göra en kvalitativ ansats där respondenterna utgjordes av sjuksköterskestuderande och verksamma sjuksköterskor. I undersökningen framkom att kroppsberöringen användes som en handling för att skapa kontakt och för att få en helhets bild om hur patienten känner sig. Sjuksköterskorna belyste även att se individen och att skapa en förståelse för det som patienten går igenom eller känner. Sjuksköterskorna framhävde också att innan de närmar sig patienten skall de tänka på att individen kanske har en annan kulturell bakgrund än det svenska. Leiningers omvårdnadsteori kan därför vara ett stöd för yrkesverksamma sjuksköterskor inom hälso- och sjukvården. Samt för att vårt svenska samhälle blir allt mer mångkulturellt. Ett annat huvudfynd som gjordes var "att inte vilja bli berörd". Detta var ömsesidigt både från patientens synvinkel liksom sjuksköterskans och syftades till närheten vi har till varandra.

Abstract The purpose of this study was to show the importance of the psysical health environment for the patients wellbeing. The question we had was; what does the literature tell us about the patients experience of the psysical health environments importance to the wellbeing? The method was a study of literature. The search for scientific articles has been done at the databases Cinahl, Academic Search Elite, Emerald, Springer Link, ADAM, BYGGDOK, Pubmed, IDEAL, Kluwer, Libris, ScienceDirect and Scirus. The keywords we used both separately and together are health facility, environment, architecture, design, art, surroundings, ward, garden, wellbeing, hospital, health, light, noise. With help of searchmonitors we searched at the keywords and names at different researchers, and also the MeSH- searchtool for translation of Swedish words into English. We have also used different homepages of the magazines or links in our search. A analyse of the content where made. The main factors for the wellbeing of the patient where; the possibility of seclusion, access to proper amount sunlight or other sources of light, the nearness to nature and fresh air and also security and support. A physical environment full of variety where also of importance as well as environments filled with music, art and other entertainment. Other findings are; the importance of creating environments adapted to the patients individual needs. The theoretical frame we used where Florence Nightingale. Keywords: health facility environment, design, architecture, art, garden, wellbeing.

Every year an avorage of 40 000 Swedes fall ill with different forms of cancer. Chemotheraphy has an effect on the tumour cells as well as the healthy cells in the body, this causes many side effects which can be very problematic for the patient. The study was carried out in order to indicate the care measures that are taken to deal with the side effects i. e stomatit, loss of hair and sickness/vomiting, that are connected with chemotheraphy so that the outpatients will experience a quality of life. The method used was a qualitative interview with six nurses from the South if Sweden, all of whom are working with chemotheraphy patients. The results showed that the nurses thought that quality of life was individual, in their care work the patients needs and valuations were used as a starting point. Aside form the specific care measures for respective side-effects they put an emphasis on talking and giving information to patients. In addition, they indicated the relationship they had with their patients. Accordi ng to them a good relation to the patient is a prerequisite of good care work.

Abstract The aim was to see how burn victims experience their situation and if they feel suffering. Then it is discussed against different perspectives of suffering. The problems were ?How does a burn victim experience their situation??, ?Does a burn victim suffer?? and ? How does the attitude inflect the suffering?? To find the answers, the authors made a literature review in which already published interviews from ordinary papers were used. In the result, the authors used the individual?s own words. The word shows that the persons suffer in many ways. For example, the look changes, the pain is constant and the people feel insecure in their life. The authors find out that a burn is a traumatic experience and it is a dramatic change in the individual?s life. An individual need to talk about the accident and the situation. It is important that the burn victim feel support so they easier can get on with their life. Sammanfattning Syftet var att ta reda på hur brännskadade människor upplever sin situation och om det förekommer något lidande. Detta diskuteras utifrån olika lidandeperspektiv. Problemformuleringarna var ?Hur upplever brännskadade individer sin situation??, ?Upplever en brännskadad individ ett lidande?? och ?Hur påverkar människans inställning lidandet??. För att belysa detta har författarna gjort en litteraturstudie där publicerade intervjuer, från vanlig dagspress, har använts. I resultatet används citat från de drabbade. Citaten visar att brännskadade individer lider på flera olika sätt. Exempel är att utseendet förändras, att alltid ha olidliga smärtor samt att individerna känner en otrygghet i sitt liv. Författarna har kommit fram till att en brännskada är en traumatisk upplevelse som förändrar individens liv radikalt. En individ behöver få prata igenom sin situation. Det är även viktigt att den drabbade får stöd för att kunna gå vidare i sitt liv.

Fuzzy set theory offers numerous methods that prove helpful in solving medical problems. They have already been successfully used for instance to fix the optimal level of drug action in patients revealing no clinical symptoms after treatment. In many morbid processes, however, although indices of measurable symptoms improve after the course of medication, the symptoms themselves do not retreat entirely. The authors have already proposed different fuzzy techniques involved in the solution of the problem described above. This time the suggestion of comparing three fuzzy decision making models aim at facilitation of the optimal drug choice in the case of symptoms that prevail after treatment.

The paper refers to earlier results obtained by the authors and constitutes their essential complement and extension by introducing to a diagnostic model the assumption that the decision concerning the diagnosis is based on observations of symptoms carried out repeatedly, by stages, which may have effect in a change of these symptoms in increasing time. The model concerns the observations of symptoms at an individual patient at a time interval. The changes of the symptoms give some additional information, sometimes very important in the diagnostic process when the clinical picture of a patient in a certain interval of time differs from that one which has been received from the beginning of the disease. It may occur that the change in the intensity of a symptom decides an acceptance of another diagnosis after some time when the patient does not feel better. The aim is to fix an optimal diagnosis on the basis of clinical symptoms typical of several morbid units with respect to the changes of these symptoms in time. In order to solve such a posed problem the authors apply the method of fuzzy relation equations, which are modelled by means of logical laws and the rules of inference. Moreover, in the final decision concerning the choice of a proper diagnosis, a normalized Euclidean distance is introduced as a measure between a real decision and an ”ideal” decision. A simple example presents the practical action of the method to show its relevance to a possible user.

Fuzzy set theory has used many auxiliary methods into the trials of solutions of some medical problems. One of the attempts was the evaluation of the optimal level of the drug action in the case when the clinical symptoms disappeared completely after the treatment. However, there can occur such a morbid process in which the symptoms prevail after the treatment. The medication improves too high or too low level of the quantitative symptom but it still indicates the presence of the illness. It is not so easy to choose the medicine, which acts best because it can happen that most of them influence the same symptoms, while they do not improve the others. A fuzzy decision making model tries to make easier to find such a drug which affects most of the symptoms in the highest degree. In the next attempt of solving the problem we propose the using of discrete membership functions in the model instead of the continuous ones. It should improve the thoroughness of the method and heighten the reliability of the accepted decision.