Våld i nära relationer är ett internationellt problem i samhället. Våld i nära relationer innebär fysiskt, psykiskt eller sexuellt våld utfört av en partner i en nära relation. Konsekvenserna för kvinnor som upplever våld i nära relationer kan leda till allvarliga skador, handikapp eller dödsfall. Det är vanligare att kvinnor blir utsatta för grövre våld än män och har därmed ett större behov av stöd och hjälp, främst från sjukvården. Sjuksköterskans kunskap är viktig då hen oftast är den första vårdgivaren som möter de våldsutsatta kvinnorna.

Palliative care means to improve quality of life for people with a life-threatening chronic illness and their family. The four cornerstones on which palliative care rests are symptom control, communication, team work and support for family. Nurses in palliative care have the task, together with the palliative team, to prevent, observe, treat and alleviate symptoms for both patient and their family members. The need for palliative care to be adapted for people with neurological disease, which includes amyotrophic lateral sclerosis (ALS), has only been noticed in recent years. For people with ALS, there can be advantages with an early contact with palliative care providers. Nurses in palliative care has a challenge to support the person with ALS in order to preserve autonomy, dignity and quality of life, and to support relatives. Amyotrophic lateral sclerosis is a collective term for several motor neuronal diseases where the most common form is classical amyotrophic lateral sclerosis. Reduced respiratory function in people with ALS lead to hypoventilation, which van be treated with ventilator support. Treatment may be either non-invasive ventilator via nasal or whole mask and with invasive ventilation via tracheostomy. Life-sustaining treatment means to replace vital functions, such as breathing, to preserve life in a life-threatening condition. The right to refuse treatment is statutory in Sweden as well as the right to renounce ongoing treatment.

The results of the study are discussed against Katie Eriksson's theories of suffering of care.

The aim of the study was to investigate nurses' experiences of withdrawal of ventilator treatment for patients with amyotrophic lateral sclerosis in palliative care.

The method used was an interview study with qualitative approach. Ten nurses were interviewed for their experience regarding withdrawal of ventilator treatment. A qualitative analysis with inductive approach was used to obtain both latent and manifest data.

The result is presented under two themes. In the theme of making the journey from worry and fear to security, it is described that the nurses before withdrawal of ventilator treatment could feel fear and anxiety, but that in most cases the conclusion was perceived as a worthy termination of treatment where the nurse alleviated suffering. Furthermore, factors are presented that can reduce the experience of concern and fear. Under this theme are the categories to practically prepare for withdrawal, to turn off ventilator treatment and preparation and processing. In the theme of balancing their own feelings that arise, the nurse's feelings of responsibility emerge and how they relate to this responsibility. In this theme, the nurses highlight what they feel is the overall responsibility of caregivers, that there is an information responsibility and that they feel a personal responsibility towards the person who wants to terminate the ventilator treatment. Under this theme are the categories team work at different levels, to relate to responsibility and the aim of the care.

Conclusions that can be drawn include; attending withdrawal of life-sustaining ventilator treatment can create feelings of concern and fear, but preparation and planning can make the experience positive. Security can be found in routines and using already existing experience, which can make nurses feel safe in the withdrawal situation.

Background

Spirituality is within into every person even though the spiritual experience is always individual. Well-being and happiness are related to the amount of spirituality influencingone’s life. Patients spiritual distress and needs often emerge from their experience of suffering. Acknowledging patients’ spirituality needs, and possessing skills to meet suchneeds, are crucial to provide holistic care; unmet spiritual needs can could increase patient ́s suffering. Spiritual care is included in registered nurses’ responsibility, althoughthe focus and involvement of spiritual care, depends on their personal experiences.

Aim

The aim was to examine registered nurses’ experiences of meeting patients’ spiritual needsin a hospital setting in Peru.

Method

A qualitative design was performed with semi-structured interviews. Nine registered nurses were interviewed, the collected data was analysed with a qualitative content analysis.

Findings

Three categories were found in the analysis; Recognition of professional responsibilities in providing spiritual care, Integrating spiritual care into clinical practice and Impact of spiritual care. The findings show how holding a holistic view impacted the delivery of spiritual care.

Conclusion

It is difficult to use specific strategies to meet spiritual needs since needs areindividual. Meeting spiritual needs must always be done with respect for the patients’ waysof expressing their spirituality. Being available and listening are important elements ofmeeting patients’ spiritual needs. Spiritual care is recognised as an inseparable part ofholistic care and the involvement of spiritual care is essential for patients healing.

The prevalence of post abortion contraception in Zambia is lower than in many other African countries, with unmet family planning needs. Midwives play an important professional role in family planning. In conjunction with an abortion the midwife is provided with an opportunity to inform, discuss, prescribe and initiate family planning with the woman concerned. It is shown that women receiving information and knowledge about post abortion contraception are more likely to use it.

The aim of the study was to describe midwives experiences of working with post abortion family planning in Zambia.

A qualitative interview study with semi-structured questions was used. To conduct the study and find participants with the right inclusion criteria a strategic sampling was used. Ten midwives working with post abortion family planning in Zambia were interviewed. Qualitative content analysis was performed to analyze the collected data from the interviews.

During the data-analysis two categories and eight subcategories were identified. The midwives had experiences of several challenges within post abortion family planning. These included lack of knowledge, supplies and health care staff as well as problem with stigma around family planning and lack of compliance. The midwives also described other factors influencing the work with post abortion family planning. These factors included changes in attitudes, the midwife's knowledge and the importance of information provided by the midwives.

The midwives experienced that there were several factors influencing their work with post abortion family planning. Several challenges within post abortion family planning were identified in this study. Areas of improvement involve education, more midwives working and a better availability to post abortion family planning equipment and services.

Background: Breastmilk contains all the nutrients an infant need. WHO recommends exclusive breastfeeding for six months and then in addition to other foods. Breastfeeding has several positive health effects for both mother and child and is also an environmentally friendly and economical way to feed a child. Most mothers want to breastfeed but many mothers quit before the baby is six months old. This could be avoided with the right support. Aim: The aim of this study was to investigate if and from where parents get knowledge and support regarding breastfeeding/nourishing before and after the child is born and what support they want. Method: Quantitative method with descriptive approach was chosen to answer the aim of this study. A cross-sectional study was conducted. A survey designed as a questionnaire with closed and open questions was distributed to parents who participated in the child's eight-month check up on the child health services through a consecutive sample. A total of 124 parents were included. Data from the closed questions were analyzed with descriptive statistics. The open questions were analyzed with qualitative content analysis. Result: Most of the parents (92%) had thought their child would breastfeed exclusively from the beginning but only 37,1 percent of the parents had planned to exclusively breastfeed for the first six months. It was 29,8 percent of the parents who stated that they had received sufficient knowledge of breastfeeding before or during pregnancy. Most commonly this knowledge had been obtained from maternal health care (59,7%) followed by the internet (43,5%). Most parents (79%) thought that they could turn to the child health services with breastfeeding issues after the child was born. It was from the child health services most (58,1%) parents received support with breastfeeding/nourishing when the child was newborn. It was also from the child health services that most parents (54%) received support when the child was older than four weeks. The parents were satisfied with the support when healthcare professionals were available, provided clear advice and security and were experienced highly competent. They were not satisfied when this failed or when healthcare professionals gave contradictory advice. The parents wanted more practical help in both breastfeeding and bottle feeding and more preparatory information during pregnancy. Conclusion: All parents do not get the information they think they need regarding breastfeeding/nourishing during pregnancy. More support and education should be provided during this time. Maternal healthcare and the internet are important sources of information and therefore suitable websites should be recommended by the midwife. The support that the parents receive after the birth of the child comes mainly from the child health services but also from other parts of the chain of care, especially during the first few weeks. The support and information provided should be consistent throughout the chain of care and should be based on a person-centered perspective, be evidence-based and not be judgmental.

Fetal movements can be an indicator of the intrauterine environment, where reduced fetal movements may interpret a placenta deficiency. When a shortage of oxygen and nutrition occurs the fetus saves energy by moving less frequently. There are a variety of methods for recording fetal movements. The methods have been created to identify a fetus at risk and the delivery might be put in advance to save the fetus’s life. There is an on-going international discussion whether the counting methods carries enough evidence. Mindfetalness is a new method to observe fetal movements, where the main focus is to record the strength, quality and characteristic of the movements without counting each and every movement.

The purpose was to observe midwives experience working with Mindfetalness at midwifery clinics.

In December 2017 data collection was conducted via a web-based questionnaire including midwives practicing at antenatal clinics, which were randomized to hand out brochures to pregnant women. The responses were analysed based on a content analysis with inductive approaches.

A majority of the midwives experienced the brochure manageable, supporting and complemented the verbal information about fetal movements. The midwives experienced that the women perceived satisfaction and felt secure receiving the brochure. A few women experienced anxiety according to the midwives. The midwives conveyed the information of Mindfetalness facilitate the women’s attachment to their unborn child. To inform about fetal movements was according to the midwives difficult but at same time important and meaningful.

Mindfetalness can be an appropriate method for midwives when informing and talking about fetal movements to pregnant women. Further research focused on the methods efficacy to identify a fetus at risk is necessary.

Vid graviditet sker flertalet kroppsliga förändringar som i kombination med förlegad och felaktig information om fysisk aktivitet kan utgöra barriärer för gravida kvinnor att utföra fysisk aktivitet. Fördelar med fysisk aktivitet avseende fysisk- och psykisk hälsa för befolkningen i allmänhet är väl dokumenterade. Studier visar att flertalet gravida kvinnor inte kommer upp i rekommenderad mängd fysisk aktivitet. I Sverige är det vanligen barnmorskan som vägleder och informerar gravida kvinnor gällande livsstil under graviditet och att stötta och ge individanpassad rådgivning är en central del i barnmorskans arbete. Forskning visar att barnmorskors kunskaper om fysisk aktivitet under graviditet är bristfälliga.

Syftet var att belysa den medicinska påverkan av fysisk aktivitet under okomplicerad graviditet för kvinnor, foster och nyfödda barn.

En litteraturöversikt har gjorts där sökning av artiklar genomförts i databaserna PubMed och CINAHL. Studiens resultatdel utgörs av femton kvantitativa artiklar publicerade mellan 2008 och 23 januari 2019, samt fyra kvantitativa artiklar funna med manuell sökning.

Det sågs ingen negativ inverkan på barnets vitalparametrar efter en och fem minuters ålder, inte heller någon skillnad mellan andelen vaginala födslar jämfört med kejsarsnitt kunde ses då kvinnan utfört fysisk aktivitet under graviditeten. Fysisk aktivitet hade en positiv inverkan på viktökningen, vilken blev mindre samt att viktnedgången postpartum underlättades om kvinnan varit fysisk aktiv under graviditeten. Även kvinnans psykiska välmående ökade samt att durationen av förlossningen blev signifikant kortare om kvinnan varit fysisk aktiv under graviditeten.

Det finns inte någon risk med att rekommendera fysisk aktivitet till friska kvinnor med en okomplicerad graviditet. Dock bör fysisk aktivitet över 90 procent av den gravida kvinnans maxpuls undvikas.

Background: The term ACS includes myocardial infarction and unstable angina. Myocardial infarction afflicts approximately 25 300 individuals in Sweden annually and to prevent recurrent ACS an extensive secondary prevention effort starts while patients are still in hospital. Secondary prevention builds upon self care where information is an important component. The information concerns a variety of areas and aims to increase the patient’s understanding and participation in lifestyle change. Just about one third of patients suffering from myocardial infarction reaches the secondary prevention goals. Previous research has shown that patients find the information received during the hospital stay unsatisfactory. Patients with a low understanding more rarely participates in secondary prevention programmes. Person centered care positively affects treatment compliance and results. The individual’s ability to change their situation is also affected by the amount of health literacy and empowerment.

Aim: The aim was to describe the need of information to obtain understanding in patients with acute coronary syndrome from sickening to cardiac rehabilitation.

Method: Mixed literature review with a systematic search strategy. In total, 16 articles were included of which half was quantitative and half was qualitative. An integrated analysis of the material was conducted in purpose of relating the results to each other and to identify similarities and differences. Thereafter categories that describe the reviewed literature were identified.

Results: In the result three main categories emerged; all information is valuable, information is requested throughout the entire care chain and adapted information is meaningful. Patients did not find any information unimportant and the information was requested at the initial phase of getting ill although the phase was characterized by shock. Even after cardiac rehabilitation and two years after ACS a need of information about pharmacological treatment existed among others, which was the information area requested in most studies. A reappearing question among patients was why the ACS had happened to them. They wished for congruence in information from different sources and found it hard to apply standardized information to their own situation. They requested individually adapted information delivered at a time when they were ready for it, that also included their family.

Conclusion: The need of information is extensive and patients did not consider any information unimportant. Even information in a state characterized by shock is requested and valuable. Individual information facilitates understanding of the relevance of lifestyle changes and enables participation. The information need varied over time and remained after two years to some extent.