This study focuses on the everyday life of young persons with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). There are follow-up studies describing ADHD, and ASD in adults, and residual impairments that affect life. Few qualitative studies have been conducted on the subject of their experiences of everyday life, and even fewer are from young persons' perspectives. This study's aim was to describe how young persons with ADHD and ASD function and how they manage their everyday life based on analyses of Internet-based chat logs. Twelve young persons (7 males and 5 females aged 15-26) diagnosed with ADHD and ASD were included consecutively and offered 8 weeks of Internet-based Support and Coaching (IBSC). Data were collected from 12 chat logs (445 pages of text) produced interactively by the participants and the coaches. Qualitative content analysis was applied. The text was coded and sorted into subthemes and further interpreted into themes. The findings revealed two themes: "fighting against an everyday life lived in vulnerability" with the following subthemes: "difficult things," "stress and rest," and "when feelings and thoughts are a concern"; and the theme "struggling to find a life of one's own" with the following subthemes: "decide and carry out," "making life choices," and "taking care of oneself." Dealing with the problematic situations that everyday encompasses requires personal strength and a desire to find adequate solutions, as well as to discover a role in society. This study, into the provision of support and coaching over the Internet, led to more in-depth knowledge about these young persons' everyday lives and revealed their ability to use IBSC to express the complexity of everyday life for young persons with ADHD and ASD. The implications of the findings are that using online coaching makes available new opportunities for healthcare professionals to acknowledge these young persons' problems.

This study describes the daily life and management strategies of young informal carers of family members or friends with mental illness. Twelve young adults (three men and nine women; 16-25 years old) in Sweden were voluntarily recruited between February and May 2008. Data collected through eight individual semi-structured interviews and one focus group interview were analysed using qualitative content analysis. The findings revealed nine subthemes that were further grouped into three main themes: showing concern, providing support and using management strategies. Participants lived in constant readiness for something unexpected to happen to the person they cared for, and their role in the relationship could change quickly from family member or friend to guardian or supervisor. Supporting a friend was considered as large a personal responsibility as supporting a family member. Their management strategies were based on individual capacities and their ability to step aside should the situation become too demanding. These young informal carers need support in caring for the mentally ill. As the internet becomes increasingly fundamental to daily life, support could be provided most effectively through person-centred web sites. © 2011 Blackwell Publishing.

The aim of this study was to explore how young (16-25 year old) informal carers of a person with a mental illness experience and use support. In a mixed method approach, we interviewed 12 young carers, and 241 completed a self-administered questionnaire. While the young carers strive to maintain control, their main support seems to be others in their lives, who often define the situation differently. The carers said web-support, counseling, and group counseling might be helpful, yet very few had any professional support. Young carers are greatly in need of support and it should be provided.

Fatigue and depressive symptoms are relatively common among patients recovering from myocardial infarction (MI). The symptoms of depression and fatigue overlap. The present study aimed at identifying patient fatigue and at examining the incidence of fatigue, particularly without coexisting depression, after MI. The sample comprised 204 consecutive patients who had completed the questionnaires Hospital Anxiety and Depression Scale and the Multidimensional Fatigue Inventory–20 after MI (1 week and 4 months). The results showed that fatigue had decreased after 4 months compared with the time of MI onset. Compared with the general population, patients reported significantly higher levels of fatigue. Furthermore, fatigue was associated with depression, but 33% of the sample reported fatigue without coexisting depression after 4 months. In order to prevent or treat patients' symptoms of fatigue after MI, the concepts of fatigue and depression should be assessed separately so as to exclude overlapping effects.

Background and RESEARCH Objective: Health-related quality of life (HRQoL) is impaired in patients after a myocardial infarction (MI), and fatigue and depression are common health complaints among these patients. Patients' own beliefs about their illness (illness perceptions) influence health behavior and health outcomes. The aim of the present study was to examine illness perception and its association with self-reported HRQoL, fatigue, and emotional distress among patients with MI. Subjects and Methods: The sample consisted of 204 patients who had had MI and who completed the questionnaires during the first week in the hospital and 4 months after the MI. The questionnaires used were the Illness Perception Questionnaire, Multidimensional Fatigue Inventory, Hospital Anxiety and Depression Scale, and the Short Form Health Survey (SF-36). Results: Patient's illness perception changed over time from a more acute to a more chronic perception of illness, and beliefs in personal and treatment control of MI had decreased. Furthermore, these negative beliefs were associated with worse experiences of fatigue and lowered HRQoL. Conclusions: Patients' illness perceptions influence health outcomes after an MI. Supporting MI patients in increasing their perception of personal control could be a primary nursing strategy in rehabilitation programs aimed at facilitating health behavior, decreasing experiences of fatigue, and increasing HRQoL. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.

AIMS AND OBJECTIVES: The aim of this study was to explore patients' illness perception of myocardial infarction four months after a myocardial infarction. BACKGROUND: An important task for research on recovery from myocardial infarction is to understand the factors that influence an individual's adherence to secondary preventive strategies. Perceptual, cognitive and motivational factors have been found to influence adherence to a secondary preventive regimen. METHOD: Twenty-five patients were interviewed four months after a myocardial infarction. In accordance with grounded theory methodology, data collection and analysis were carried out simultaneously. RESULTS: The findings can be understood in light of two core categories: 'trust in oneself ' vs. 'trust in others'; belief in one's own efforts to control the illness; and 'illness reasoning', lines of thought about illness identity. In searching for relationships, six categories describing variation in illness perceptions of a myocardial infarction emerged: (i) 'sign of a chronic condition - feasible to influence'; (ii) 'sign of a chronic condition - uncontrollable'; (iii) 'acute event that can recur - feasible to influence'; (iv) 'acute event that can recur - uncontrollable'; (v) 'unthinkable acute event'; and (vi) 'non-recurring acute event'. CONCLUSION: The more reflective patients perceived the heart attack as a sign of a chronic condition; they also devoted time for reasoning about the possible causes of their illness. This is in contrast to patients who were less reflective and viewed their myocardial infarction as an acute event, which they avoided thinking about. The findings contribute to our understanding of variation in illness perceptions. RELEVANCE TO CLINICAL PRACTICE: The examination of how individuals perceive myocardial infarction may help health-care professionals individualize secondary preventive strategies, thereby improving adherence to health-care regimens. Nurse-patient discussions could begin with identification of the patient's variations of reflectiveness concerning his/her illness.

Background: Relatives of a person suffering from cancer risk being affected both physically and psychologically. Blogging has become increasingly popular as a forum for communicating experiences, but few studies have focused on what blogging about a relative's cancer journey means to the author. Aim: To illuminate relatives' experiences of blogging when a family member is in the end-of-life phase of cancer. Method: Telephone interviews were conducted with 12 people about their experiences of blogging during and after their family member's illness. The data was analysed using qualitative content analysis. Findings: Blogging facilitated everyday life, introduced the relatives to new friends with similar experiences, helped them in their grief process, and helped them to preserve memories. The negative aspects were being misunderstood and publicly criticised as well as the feeling of providing readers with 'reality show' entertainment. Conclusion: Blogging was seen as a complement to professional care that contributed to the prevention of ill health.

A range of programmes and new vocations emerge as an answer to societal changes that suggest new work functions as well as new sub-specializations of already existing professions and work functions. In 2010, a multidisciplinary designed training programme started at the University West in Social Psychiatric Care (SPC). The new occupation can be said to fall within the category of pre-professions, a third generation of professionals seeking professional status. The possibility for employment is broad and unspecified and in worst case might go no further than the students' hopes of new careers. Against this background, an inside perspective is given from students experiences. The purpose was to gain a deeper understand of student's trajectory through a new education into the labour market. Eleven female students were interviewed prior to graduation. A hermeneutical phenomenological approach was conducted in order to identify central themes important in students professional becoming. As preliminary result three themes were identified. The theme 'tensions between high and low position' concerning level of involvement in treatment and care or in morea dministrative leading function, were connected to power and payment. The theme 'generalistor specialist' concerned specialist in the respect of expert on broadness suitable for coordinating positions, otherwise broadness was defined as knowing everything anddifficulties in finding professional identity. The theme 'change and tradition' concerned questions concerning establishment where new vocations seek legitimacy among employers and colleagues in the workplace. Standing at the threshold to labour market is an existentially challenging position between hope and despair.

Background: One in ten couples suffers from some form of involuntary childlessness or infertility in Sweden. Involuntary childlessness or infertility is when an individual or a couple has a desire for a child but are unable to conceive on their own. To suffer from involuntary childlessness can be a mental strain that can result in a personal crisis, where the existential issues become central and contested. Regardless of the reason for their changed life world is because of involuntary childlessness or infertility, it is always important for the nurse to have an understanding of individual’s life-changing world and experiences. 

Aim: The aim of the study was to describe men and women experiences of involuntary childlessness during investigation and treatment.

Method: Selected method was a literature review. The study was based on articles from systematic and unsystematic searches in databases and analyzed from the chosen method.

Results: Four main themes emerged from the analysis, 'The changing life-world', 'The mental strain', 'Perceptions of relationships and social life' and 'experiences related to treatment'.

Conclusion: Being involuntarily childless and infertile create a mental, physical and social stress. Clinically, this means a responsibility to offer a personalized support. For the nurse it is important to have an understanding of individual life-world and how the involuntary childlessness affects them.

Poor adherence to asthma medication treatment is a dilemma as it decreases the chance of achieving and maintaining a proper asthma control. Another dilemma is that there seems to be a small range of functional interventions that enhance adherence to long-term medication treatments. The aim was to review the last five years of published educational interventions for improving adherence to asthma medication. Through systematic database searches 20 articles were identified, which matched the inclusion criteria and described educational interventions to improve asthma self-management including adherence. The current review showed that addressing unintentional non-adherence in terms of incorrect inhaler technique by recurrent education improved the technique among many patients, but not among all. Phoning patients, as a means to remove medication beliefs as adherence barriers, seemed to be an effective educational strategy, shown as increased adherence. Involving patients in treatment decisions and individualising or tailoring educational support also seemed to have favourable effect on adherence. To conclude, addressing specific adherence barriers such as poor inhaler technique or medication beliefs could favour adherence. To change adherence behavior, the current review proposes that educational adherence support should be a collaborative effort between the patient and the health-care professional based on each individual patient's needs and patient factors, including elements such as personality traits.

Background and Aims

Failure of ileal pouch-anal anastomosis (IPAA) occurs in around 10% of the patients. Compared to patients with functioning pouches, health related quality of life is deteriorated after failure. Sexual function in patients with pouch failure is however poorly studied.

The aim was to study sexual function in patients with pelvic pouch failure; patients with functioning pouches were used as controls. The hypothesis was that patients with pouch failure have worse sexual function.

Methods

36 patients with pouch failure were compared with 72 age and sex-matched controls with ulcerative colitis and functioning pouches. The patients answered a set of questionnaires concerning sexual function (Female Sexual Function Index [FSFI] and International Index of Erectile Function [IIEF]), body image (BIS-scale) and health-related quality of life (SF-36).

Results

Both women and men with pouch failure scored lower than controls in the FSFI and IIEF questionnaires. However, none of the observations were statistically significant. The scores in the failure group (for both sexes) were below the cut-off level for sexual dysfunction. Scores for the BIS instrument were significantly lower for both sexes in the failure group. Women and men in the failure group scored lower than the controls in all domains of the SF-36, however statistically significant only for the social function domain in men.

Conclusions

The hypothesis, that a failed IPAA is associated with worse sexual function, was not confirmed. Compared to patients with functioning pouches, patients with pouch failure have inferior body image.

Clinical nursing supervision enables supervisees to reflect on ethically difficult caring situations, thereby strengthening their professional identity, integrating nursing theory and practice, and leading to the development of ethical competence. The aim of this study was to develop an understanding of the core ethical issues of clinical nursing supervision, using previous research as well as philosophical analysis of the theories of three moral philosophers: Harald Ofstad, Richard Hare and Carol Gilligan. The ultimate aim of this study was to develop a general model for ethical decision-making and to establish its relevance for clinical nursing supervision. The findings highlight four important values for the development of a basis for ethical decision-making. These values are caring, dignity, responsibility and virtue.

Aim: To explore community nurses' experiences of decision making within the community provider organization. Background: Recent changes in health care with an increasing number of patients being cared for outside of institutions can put considerable pressure on the nurse with respect to decision making. Methods: In-depth interviews were performed with 6 registered nurses in two communities. The interviews were analysed by means of phenomenological hermeneutics. Results: The community nurses' experiences of decision making were interpreted as spiders or octopuses, consultants and troubleshooters. The subthemes were; networking and structuring, responsibility, availability and knowledge, assessment power, information selection, avoiding rules and bypassing managers. In accordance with hermeneutical phenomenology, the findings were discussed and explained with reference to Ofstad's philosophy of freedom to make decisions. Conclusion: In their decision making, community nurses are committed to finding administrative solutions that satisfy patient needs.

Diabetes self-management is a challenge for both clients and health-care professionals. Empowerment plays a vital role in helping clients to achieve successful self-management. This study adopted a meta-ethnographic approach. Nine qualitative studies were synthesized in order to contribute to a deeper understanding of what clients perceive as being important in an effective empowerment strategy for diabetes self-management. Four central metaphors that influenced empowerment were identified: trust in nurses' competence and awareness, striving for control, a desire to share experiences, and nurses' attitudes and ability to personalize. The lines-of-argument synthesis suggested the need for an evaluation system to appraise clients' diabetes knowledge, health beliefs, and negative emotions, as well as the outcome of interventions. Based on Pender's Health Promotion Model, this study emphasizes the fact that health-care professionals need to understand and address modifiable behavior-specific variables. The study suggests that an effective empowerment strategy would be to use activity-related affect, as well as interpersonal and situational influences, as a means of facilitating and enhancing clients' health-promoting behaviors.

The aim of this study was to investigate the influence of clinical supervision on nurses´

moral decision making. The sample consisted of 15 registered nurses who took part in

clinical supervision sessions. Data were obtained from interviews and analysed by a

hermeneutic transformative process. The hermeneutic interpretation revealed four

themes: increased self-assurance, an increased ability to support the patient, an increased

ability to be in a relationship with the patient, and an increased ability to take responsibility.

In conclusion, it seems that clinical supervision enhances nurses´ ability to provide

care on the basis of their decision making. However, the qualitative and structural aspects

of clinical supervision have to be investigated further in order to develop professional

insight into the way that nurses think and react. 

BACKGROUND: The role of the nurse supervisor is very important, because of his/her ability to influence the atmosphere within the clinical nursing supervision group. AIM: To present and interpret nurse supervisors' different ethical decision-making styles. METHOD: A hermeneutic interpretation of three studies on nurse supervisors' different ethical decision-making styles. RESULTS: The significance of the nurse supervisor's ethical decision-making style is reflected in the awareness of their responsibility for creating a relationship with the supervisee. The supervisors focus on ensuring safety, integrating theoretical knowledge and clinical practice, willingness and preparedness to supervise on the substance of nursing, sharing the supervisees' feelings and challenging them, reflecting on the content of clinical nursing supervision as well as promoting justice and integrity in clinical nursing supervision. CONCLUSIONS: The interpretation highlights the importance of the nurse supervisor's style for the outcome of clinical nursing supervision, as they are role models for the supervisees. There is a need for further research to explore the advantages and disadvantages of nurse supervisors' different ethical decision-making styles, especially in relation to the influence of clinical nursing supervision on the quality of care and various support systems.

AIM: The principle of human dignity has assumed importance in ethics and constitutional law throughout the 20th century in the Western world. It calls for respect of each individual as unique, and of treating him or her as a subject, never as a mere object. As such, the principle constitutes an ethical cornerstone in health care. Patients suffering from Ehlers-Danlos syndrome (EDS) challenge medical care and knowledge in health-care professionals' as symptoms sometimes are vague. Individuals with this disorder have reported not being respected when seeking health care.

PURPOSE: To describe encounters in health-care situations when individuals suffering from EDS experienced that their dignity was not fully upheld. A further aim was to describe the long-term consequences of these experiences.

METHOD: A study-specific questionnaire was designed, where individuals with EDS described their encounters with health care from a personal perspective.

RESULTS: After qualitative content analysis, the following five categories were identified: 'Being ignored and belittled by health-care professionals,' 'Being assigned psychological and/or psychiatric explanations', 'Being treated and considered merely as an object', 'Being trespassed in one's personal sphere' and 'Being suspected of family violence'. Consequences of these encounters were 'Mistrusting the physician' and 'Risking bad health'.

CONCLUSIONS: The memory of not being respected is substantial for individuals with EDS and can last for years. As a result, lack of trust for the health-care system is created and they may experience difficulties in future encounters with health care. Therefore, health-care professionals should base their actions on norms that protect human dignity and confirm each patient as a unique human being with resources and abilities to master their own life.

In today’s health care it’s most common to treat an illness with a kind of pharmaceutical preparation. But lack of resources, given information and bad communication and collaboration between the patient and the nursing staff can lead to a patient unwilling to follow the doctor’s prescription. This does not just affect the individual patient’s health but it can also result in consequences for other people and the whole society. The purpose of this study was to analyse studies about the concepts compliance and concordance in order to illustrate why patients with chronic illnesses fail to follow their prescriptions. Our method has been to read and analyse the methods and results of articles out of the perspective similarities and differences of the concepts compliance and concordance. It was hard to keep the concepts separated because of their similar meanings. Our result shows that the method used was interviews with questionnaires which has been analysed on the basis of the qualitative studies’ themes and categories. The quantitative articles’ data were displayed statistically. Our analyse showed that patients often lack knowledge about their medical treatment which affects their attitudes and can lead to bad compliance and concordance. As a nurse it’s therefore important to identify the cause that affects the patient. The nursing staff’s goal ought thus to be to get the patient involved as much as possible in their self-care. If the patient is involved in hers/his treatment, it’s more likely that they feel a responsibility towards themselves and therefore gets a better quality of life.

Purpose – Earlier studies have identified artefacts, but have only to a lesser degree looked at theireffects. The purpose of this paper is to investigate how artefacts contribute to organisation. Design/methodology/approach – A trauma team at a university hospital has been observed andits members interviewed. Findings – The trauma team showed itself to be rich on artefacts since it had strong internal drivingforces, high legitimacy, and tried to live up to high expectations from the outside. Its members were motivated to be in the forefront of trauma care. Through renewal, the team succeeded in maintaining demarcation. It also succeeded in systemising internal work tasks and made for itself a position in relation to the outside. The team's capacity, however, came to be limited by internal conflicts and battles for prestige. Practical implications – The study shows that informal logic has a strong influence on teams.Teamwork contributed to the development of organisational structure and motivation for the personnel. Originality/value – Earlier studies advocate the important role of artefacts in order to communicate, collaborate, negotiate or coordinate activities. The conclusion is that artefacts also have an organising and developing effect on teams in a fragmented and differentiated healthcare.

Samverkan mellan olika yrkesprofessioner på en olycksplats är komplicerat. Mycket på grund av att förväntningarna inte alltid överensstämmer med förutsättningarna. I boken problematiseras agerandet på olycksplatsen. Friktionen mellan yrkesprofessioner lyfts fram och olika beteendemönster diskuteras.I boken tar författarna samverkan från retorik till ett praktiskt redskap, något som är möjligt att konkretisera och utföra praktiskt i det dagliga arbetet. Boken utgör samtidigt en introduktion till övningstekniken 3-nivåsamverkan (3-NS).I den här boken bjuds på flera närgångna beskrivningar. Medarbetare från fältet berättar om sina erfarenheter av samverkan, hur den tillämpas, om vilka möjligheter som finns och vilka svårigheter som behöver hanteras.Boken riktar sig till alla som arbetar i eller i anslutning till blåljusorganisationer. Den kan med fördel användas som lärobok för universitets- och högskolestuderande som läser till yrken inom polis, räddningstjänst eller ambulanssjukvård. Boken passar också för vidareutbildning av redan yrkesverksamma. Den kan även med fördel läsas av forskare, tjänstemän och politiker med intresse för hur framtidens blåljusorganisationer ska ledas, organiseras och styras.

Artefacts reveal an organisation's ''inner life'' and they contribute to its image and reputation. They also play a decisive role for an organisation's development. In this article, similar artefacts from two different health care teams—a trauma team and a psychiatric team—in the same hospital, are compared. The team members were interviewed and their work observed over the course of several years. It was demonstrated that identical pieces of equipment in a trauma team and a psychiatric team signalled opposite values. The psychiatric team was backwardlooking, conservative and contradictory. Modern technology and pieces of equipment were associated with an abandoned and previously criticised activity. The corresponding equipment in the trauma team, on the other hand, signalled a forward looking, developing and unified culture. The trauma team was a relatively new and powerfully idealised phenomenon, which attracted attention. The analysis points out how the symbolic values signal that one activity is attractive and pleasing while another has a low external legitimacy. 

I den här studien fokuseras den starka passion som finns för typologier inom teamforskningen. Det finns typologier av teamprocesser, strukturella teamtyper och modeller för implementering av teamarbete. Vid första anblicken kan man i vissa fall få intrycket av att modellerna utvecklats utan att vara baserade på empiriska fynd och i andra fall att modeller blir en sorts självuppfyllande profetior som döljer möjligheten att urskilja variationer ur empiriska fynd.

Syftet med denna artikel är att granska samband mellan ett antal typologier och diskutera varför teamarbete uttrycks som stegvisa utvecklingsmodeller. Speciellt fokus läggs på trestegsmodeller, så kallade triader.

Vi har identifierat och analyserat fem teoretiska triader som beskriver teamarbete. Forskningsfrågan för denna artikel är: Är teamtypologierna värderande på så sätt att de särskiljer excellenta team från mindre framgångsrika, eller klassificerar de utan att värdera teamens grad av excellens? Är de teoretiska modellerna sorterande eller värderande?

Fysiska och psykiska besvär kan påverka hälsan och i förlängningen sexualiteten. Ett exempel är patienten som har diarréer, ont i magen och förlorar vikt och energi orsakat av en inflammatorisk tarmsjukdom.  Medan att ha en cancer i colon eller rektum ger oftast inga besvärliga symtom, inte i början. Men för patienten med cancer påverkar behandlingen i form av strålning, kirurgi och cytostatika bla. sexualiteten.

Det är viktigt att sjuksköterskan är medveten om patienten påverkas även sexuellt. Sjuksköterskan kan vanligtvis prata med patienten om privata saker som tex. avföringsvanor och om döden. Sjuksköterskan skall även ges information om sexualiteten, och frågor skall kunna ställas av patienten och eventuell partner. Sexualiteten betyder olika mycket för olika personer och vid olika tidpunkter i livet. Att negligera patientens behov om att prata om detta eller resonera som att de får någon annan ta upp om (läkaren) är inte rätt. Människan är en sexuell varelse.

Background

Today is length of staying at the hospital only some days even after large surgery. In the literature it is well-known how many days the patients stayed at hospital, how much pain they had after surgery and how many days they felt sick. But we didn't know the patients experienced the first hours at the nursing ward after surgery and who get through the first time at home after early getting home.

Aim

The aim was to describe patients experience of ”early getting home” after intestine surgery.

Patients and method

Seven women and three men who had been operated with large intestine surgery was included in the study. They was stay between two and four days after surgery at the hospital. After the patient getting home a nurse had a telephone call after a couple of days. They have a visit at outpatient clinic visit by three to five weeks later at the surgeon. At the same time interviews were making about 30 minute, the interview was typewriter exactly. The analyse method was on data was phenomenology.

Result

The patients felt trust to the caregivers, but the strongest supports were experienced from the relatives who had involved and engaged in their situation. The study showed that all patients trusted in caring, staff and doctors but they also said that they didn’t ha any other choice. The patients experienced the treatment from the nursing staff often as good. Throw the caregivers attention the patients felt that they had been seen and felt confirmed. The patients experienced fear and worry which come from loosing their control over the situation. The patients described health was the same as quality of life, to be with family or to have friends and be active in life.

Conclusion

All patients who had relatives support at home experienced their early getting home as positive. The following telephone call home from nurses were imported and was a part of satisfaction, but the largest support they had were the relatives who had involved in their situation.