| 1. |
- Dahlberg, Anna-Karin, 1985-
(författare)
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Environmentally relevant chemical disruptors of oxidative phosphorylation in Baltic Sea biota : Exposure and toxic potentials
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis focuses on toxicity and occurrence of hydroxylated polybrominated diphenyl ethers (OH-PBDEs) in Baltic Sea biota. The aims were to assess OH-PBDEs potency for disruption of oxidative phosphorylation (OXPHOS) and determine their and related compounds exposure in Baltic blue mussel, herring and long-tailed duck. A method for analysis of OH-PBDEs in herring and long-tailed duck plasma was also evaluated.Relevant OH-PBDEs were tested in vitro for OXPHOS disruption, using a classic rat mitochondrial respiration assay and a cell mitochondrial membrane potential assay. All compounds were found to disrupt OXPHOS either by protonophoric uncoupling and/or via inhibition of the electron transport chain. 6-OH-BDE47 and 6-OH-BDE85, were identified as particularly potent OXPHOS disruptors. Strong synergism was observed when OH-PBDEs were tested as a mixture corresponding to what is present in Baltic blue mussels.Baltic blue mussel is main feed for several species of mussel feeding sea ducks which have decreased dramatically in numbers. To assess long-tailed ducks exposure to brominated substances, liver tissue from long-tailed ducks wintering in the Baltic Sea and blue mussels were analysed. The result confirms that long-tailed duck are exposed to OH-PBDEs via their diet. However, low concentrations were found in the duck livers, which suggest low retention of these compounds despite daily intake. How the nutritional value of blue mussels as feed for sea ducks are affected by OH-PBDE exposure still needs further studies. Other species of sea ducks foraging on Baltic blue mussels during summer months can also be more exposed due to seasonal variation in primary production.Herring sampled in the Baltic Proper and Bothnian Sea, were found to contain OH-PBDEs and high levels of their methylated counterpart, MeO-PBDEs. As demethylation of MeO-PBDEs is known to occur in fish, MeO-PBDEs may pose as additional source for more toxic OH-PBDEs in herring and their roe.
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| 2. |
- Petersson, Bengt-Olof, 1948-
(författare)
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Handledning för vårdare - ett lärande möte utifrån patientens värld
- 2010
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The present research study is a supervision project which was carried out between 2004-2006. The overall aim of the research was to investigate how caring science supervision can support carers in integrating caring science and can contribute to a constructive way of integrating caring science knowledge with praxis.The research project consisted of supervision given to groups of carers in two different contexts where a caring science model for supervision was tested and developed.The experience of how carers integrate caring science knowledge through supervision has been studied by interviewing carers. Seven were interviewed in the first study about how they experienced their own learning process by participating in group supervision. The second study focused on how the supervisor’s selection of different supervision methods can support the carers’ development and understanding for the patient’s lifeworld.The interviews were analysed with the help of a reflective lifeworld approach. The results from the seven interviews consisted of a description of the essence and seven constituents. The results show that knowledge about caring, from the carers’ point of view, is an attitude that is taken for granted. With this as a starting point the carers listen and read what has happened to the patient in different situations. In the supervision session the carer and the supervisor have worked out a critical caring science investigation of the patient’s situation and developed new strategies for the patient’s caring. The interviewed carers point out the importance of a free zone, a learning room in supervision, where they can reflect and, in a constructive dialogue with each other, work with the patient’s situation together with the supervisor.In the second research study the supervisor’s selection of methods in supervision is in focus. The aim of using these different methods was to support the development of knowledge grounded in caring science. The supervision methods support the carers in the reflection process and stimulate them to develop good skills in the relationship with the patient. The results also show, in two ways, how important the supervisor’s role is for the supervision process. Firstly in terms of being able to see and understand what the focus is in the carer’s narrative of the patient’s situation. Secondly how the selection of an appropriate method can support the carers’ understanding of what obstacles there can be and which possibilities there can be for the caring of the patients. This work in the supervision process demands that supervisors are aware of how the group process can be integrated with the learning process.Keywords: caring science, phenomenology, lifeworld, reflection, dialogue, supervision, supervision methods.
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| 3. |
- Summer Meranius, Martina, 1971-
(författare)
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"Era delar är min helhet" : En studie om att vara äldre och multisjuk
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis is to describe what it means to be old and live with multimorbidity. An additional aim is to examine and describe the contextual meaning of the phenomenon in ordinary housing and nursing homes, and a third aim is to deepen our understanding of the situation for old people who also are ill. The thesis uses a caring science perspective and a reflective lifeworld approach founded on phenomenological philosophy. This approach searches for and describes the meaning of a phenomenon, its variations and its essential meaning structure. Interviews were used for data collection and data were analyzed for meaning, searching for the essence of the phenomenon. The findings are presented in two empirical studies and one philosophical excursion. The empirical studies have been further thematized with the essential meanings from the empirical studies. The philosophical excursion is the result of a more profound understanding of the thematized meanings.The essential meaning of being old and living with multimorbidity in ordinary housing is described as a struggle to maintain identity in a life situation that changes. Multimorbidity and aging pose existential barriers at the same time as the possibility of living an independent life and being oneself is hindered. Ordinary housing is experienced as a place where the old can be themselves, and a place that is associated with independence. On the other hand, multimorbidity threatens the possibility of continuing to live in their private homes, as does the failure of others to meet the old as individuals.The essential meaning of being old and living with multimorbidity in nursing homes is described as striving for independence which brings with it a zest for life and a feeling of security. The older’s degree of independence can change due to the fragile health situation, and is characterized by the experience of not being a burden for the busy caregivers and relatives. Independence can change to insecurity, vulnerability and helplessness.The themes of essential meaning that have been extracted from the empirical studies suggest that the experiences of frailty and loneliness differ more between those living in ordinary housing and in nursing homes than the experiences of trust and independence differ.The philosophical excursion illuminates how older people with multimorbidity experience their lives as an ability to manage their daily lives and not merely an absence of disease symptoms. A person is “just” sick, independently of the objective quantity of diseases s/he may suffer from. Health and wellbeing occur from the ability to live in existential coherence, which is encouraged when the older people are allowed to retain their habits, the ability to be oneself, individual’s life story and by social relationships, as well as by continuity among the caregivers.
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| 4. |
- Asp, Margareta, 1958-
(författare)
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Vila och lärande om vila. En studie på livsvärldsfenomenologisk grund
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Avhandlingsarbetets syfte var att utifrån människors levda erfarenheter av vila, utveckla en tentativ teori om vila och om lärande avseende vila. Den kunskapen har utgjort grund för att beskriva hur förutsättningar för lärande avseende vila kan skapas. En modell för lärande avseede vila har utvecklats, i vilken en ömsesidighet mellan innehåll, lärande och förutsättningar för lärande beaktas. Studien genomfördes med en livsvärldsfenomenologisk ansats och med intervju som datainsamlingsmetod. Analysen genomfördes enligt en beskivande fenomenlogisk metodologi, i syfte att beskriva fenomenets generella struktur En generell struktur av fenomenet vila, implicerar en dualitet mellan vila och icke-vila. Essensen i vila utgörs av en harmoni i vilja, känsla och handling Vilan gestaltas i och med att en inre verklighet avseende behov och längtan överensstämmer med den yttre verklighetens beskaffenhet. Till vilans essens relateras innebördselementen: vilorytm i livet, stämningar av skönhet och trevnad, bejakad utan bedömning, frihet från bekymmer och tvång, samvaro med gemensamt intresse, att dröja, lustfylld stimulans och lustfylld utmaning. Essensen i icke- vila är disharmoni i vilja, känsla och handling. Upplevelsen av disharmoni tär på krafterna och blir allt påtagligare ju längre icke-vilan pågår. Att lära sig vila innebär att bli medveten om sitt behov av att ha en livsrytm som ger utrymme för vila, att tillåta sig att leva i en sådan rytm och att finna eller skapa källor där kraft kan hämtas. Modellen för lärande avseende vila består av tre dimensioner: lärande om vila, lärande i vila och lärande genom vila. Lärande om vila kan relateras till idëer om livsvärld, levd kropp, tid och rum, cirkularitet och intentionalitet. Lärande genom vila kan relateras till hälsa och lärande i vila kan relateras till etiska och estetiska aspekter.
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| 5. |
- Bremer, Anders, 1957-
(författare)
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När livet skakas om : patienters och närståendes erfarenheter av hjärtstopp utanför sjukhus
- 2008
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- I Europa vårdar ambulanspersonal årligen cirka 300 000 människor med hjärtstopp. Ungefär en av tio överlever. Tidigare forskning har inte i någon större utsträckning berört hur överlevande patienter och närstående mår efteråt eller vilka etiska aspekter och problem som möter ambulanspersonal i dessa situationer. Med hjälp av en reflekterande livsvärldsansats är syftet med denna licentiatavhandling att beskriva vad det innebär att överleva hjärtstopp utanför sjukhus respektive närvara vid en nära persons hjärtstopp. Med utgångspunkt i det empiriska resultatet är syftet att belysa och diskutera etiska aspekter och problem av betydelse för ambulanspersonals vårdande ur ett normativt perspektiv.Avhandlingens empiriska resultat visar hur ogripbart det är att drabbas av hjärtstopp och hur uppvaknandet ur medvetslösheten innebär vilsenhet och kontrollförlust genom den minneslucka som tillfogats. Att överleva innebär därför ett sökande efter sammanhang så att situationen kan ges mening och förklaring till tankar, känslor och upplevelser. Känslan av sammanhang nås via andra människors berättelser tillsammans med egna minnen. I det fortsatta livet finns existentiell rädsla och otrygghet där den egna identiteten och meningen i livet omvärderas i takt med en växande insikt om hur den egna kroppen påverkats av hjärtstoppet. Ibland upplevs kroppen som begränsad vilket skapar otrygghet och rädsla. I det fortsatta livet kan det finnas skuldkänslor för det inträffade likväl som att hjärtstoppet ses som en opåverkbar händelse. Men det finns även tacksamhet och glädje över välbefinnande och trygghet i ett förändrat liv där vardagliga sysslor ger tillvaron en viss stadga. Det passerade livshotet införlivas i ett liv där mänskliga relationer blivit än viktigare värden i ett gott liv.Närvaro vid en nära persons hjärtstopp omkullkastar känslan av kontroll. Allt upplevs overkligt, tiden tycks stanna upp och samtidigt är verkligheten extremt påtaglig. Förvåning övergår snabbt till ett kaos av tankar och känslor där panik, chock och fruktan griper tag. Verkligheten innebär ett överväldigande och ensamt ansvar där närstående känner sig otillräckliga. Väntan på professionell hjälp känns lång och det är en befriande känsla då ambulanspersonal anländer och övertar ansvaret. Samtidigt väcks hopp om att patienten ska överleva. För närstående är allt kaotiskt, ångestfyllt och omtumlande då de kastas mellan hopp och misströstan för att slutligen få ett overkligt och ogripbart besked om den nära personens överlevnad eller död. Livets grundvalar skakas om och uppmärksammar livets skörhet och att inget kan tas för givet. Efter händelsen finns obesvarade frågor och oro som riskerar att leda till ensamhet i sorg eller i en oro för den överlevandes framtid. Oavsett vilket, riskerar ensamheten att leda till uppoffring av egna och viktiga behov.I ett gott beslut balanseras etiska normer att rädda liv, rätten till värdig/god död, autonomiprincipen samt att göra gott och inte skada. Den övergripande normen vid hjärtstopp är att rädda liv. Att i det akuta skedet avgöra om patienten räddas till ett acceptabelt liv är svårt. Det empiriska resultatet ger dock stöd för att återupplivning bör göras vid behandlingsbara hjärtstopp samtidigt som resultatet visar hur svårt det är att dra en gräns för vad ett acceptabelt liv är. Undantagsvis är det goda beslutet att avstå från eller avbryta återupplivning, exempelvis vid förekomst av ett giltigt förhandsdirektiv. En värdig/god död är då det primära. Ett utökat etiskt ansvar för ambulanssjuksköterskor kan vara att de ges beslutsrätt för avbrytande av återupplivning. Ett annat ansvar handlar om möjligheten att främja ett gott liv för överlevande genom att efteråt bidra med kunskap som kan skapa förlorade sammanhang. Ansvaret för närstående kan innebära att meningslös återupplivning inte görs ”för deras skull” utan att deras behov möts på bättre sätt.
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| 6. |
- Bremer, Anders, 1957-
(författare)
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Vid existensens gräns : Etiskt vårdande och professionellt ansvar vid hjärtstopp utanför sjukhus
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: To describe and interpret patients’, family members’ and ambulance personnel’s experiences with regard to survival, attendance, and caring at cardiac arrests and deaths, and to analyze ethical conflicts that arise in relation to families and how the personnel’s ethical competence can affect caring and the ability to handle ethical problems.Method: The three interview studies were guided by a reflective lifeworld approach grounded in phenomenology and analyzed by searching for the essence of the phenomenon in two studies and by attaining a main interpretation in one study. In the fourth study, the general approach was supplemented by “reflective equilibrium” that guided the ethical analysis.Results: The survivors are striving towards a good life by means of efforts to reach meaning and coherence, facing existential fear and insecurity as well as gratitude and the joy of life. Family members lose everyday control through feelings of unreality, inadequacy and overwhelming responsibility. Ambulance personnel’s care mediates hope and despair until the announcement of survival or death. After the event, family members risk involuntary loneliness and anxiety about the future. For the ambulance personnel, caring for families involves a need for mobility in decision making, forcing the personnel to balance their own perceptions, feelings and reactions against interpretative reasoning. To base decision making on emotional reactions creates the risk of erroneous conclusions and a care relationship with elements of dishonesty, misdirected benevolence and false hopes. Identification with family members can promote recognition of and response to their existential needs, but also frustrate meeting family members emotions’ and handling one’s own vulnerability and inadequacy. It was found that futile cardiopulmonary resuscitation, administered to patients for the benefit of family members, is not an acceptable moral practice, due both to norms of not deliberately treating persons as mere means and to norms of taking care of families.Conclusions: Ethical conflicts exist when it comes to conveying realistic hope, relief from guilt, participation, responsibility for decision making, and fairness in the professional role. Ambulance personnel need support to enhance ethical caring competence and to deal with personal discomfort, as well as clear guidelines on family support.
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| 7. |
- Carlsson, Gunilla
(författare)
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Det våldsamma mötets fenomenologi : - om hot och våld i psykiatrisk vård
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The present study focuses on the phenomenology of the violent encounter, and is to be understood as the study of the violent encounter as a phenomenon, i.e. as experienced. The overall aim is to elucidate, analyse and describe violent encounters within psychiatric care as experienced by carers and patients. Moreover, the study aims at promoting the development of a phenomenological research approach in caring science in general and elucidating tacit caring knowledge in particular.The thesis includes three empirical studies and one methodological study. The research is guided by a phenomenological and lifeworld theoretical approach. Research data consist of narratives and qualitative interviews, as well as reenactment interviews with carers and patients. Data are analysed for meaning. The analysis and synthesis of meaning are aimed at openness and meaning sensitivity through a reflective attitude characterised by the intent to bridle the process of understanding. The goal of the analysis is to describe the general structure of the phenomenon and its meaning constituents.The result shows that violence and threat do not evolve in “naked” caring, characterised by encounters where carers are able to touch their patients at the same time as being touched, speaking both literally and figuratively. It is through “naked” caring and caring touch that the carers are able to reach the patients and to give undisguised invitations to genuine presence. The possibilities of touch rely on the carers’ capacity to be authentic and to genuinely wish well. Violence is on the contrary nourished by touch without caring intention, or non-touch, i.e. caring where the reciprocity of touching and being touched is missing between patients and caregivers.In the discussion, the different meanings of the violent encounter are related to the philosophy of Merleau-Ponty and Lévinas. The philosophical dimensions of touch are investigated and it is discussed how the “naked” encounter can be understood from a phenomenological ethical standpoint. The discussion focuses on the caregivers’ vulnerability and the high demands they are subjected to. It is also argued that a foundation of caring science is needed in caring practice in order to make possible a development of a caring attitude that prevents violence.
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| 8. |
- Chow, Judy, 1954-
(författare)
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Vårdandets Tao : En fenomenologisk studie om vårdrelationer i Kina
- 2008
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis researches the phenomenon ‘caring relationship’. The empirical studies in this thesis were carried out in China with the aim to describe the caring relationship in China through the lifeworld experiences of professional caregivers and patients. The result of this study will later on relate to a study of Swedish caring relationships. For this phenomenological study 9 patients, 10 medical and healthcare workers and 4 nursing tutors were interviewed. They were from 5 different medical and care units from two hospitals, one private clinic and a nursing school in Southern China. This study shows that caring relationship in China has many layers. Embedded in the basic interpersonal relationship is a ‘relationship of need’. The relationship carries a goal: to help the patient to restore a personal harmonic existence and regain the responsibility for their health. The relationship is temporary and normally ends when the goal is achieved. The relationship is initiated by the patients need for help. The two main actors in the caring relationship are the patient and the caregiver with their roles as care seeker and care provider. This study shows that to become a patient is a process of diminishing the natural ordinary self which makes the person feel vulnerable. Caregivers take a leading role which carries responsibility. They feel an obligation to use all their knowledge and resources for the benefit of the patients. They teach them how to live and how to stay healthy. A main function in the caring relationship is the transfer of knowledge. The caregivers feel the need to create a dialog to get access to the patients’ unique knowledge about themselves so that the caregiver’s general knowledge of health and care can be applied to the individual. Through the informal chats they share the patient’s experiences, emotions and history. It creates en opportunity for the interpersonal relationship to grow deeper and for the patient and the caregiver to meet as fellow human beings. In the Chinese caring relationship the patient’s family is included. It is considered to be every contributor’s duty to be responsible for oneself and for others. Mutual understanding and respect in a caring relationship are important in getting the patient back into balance.
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| 9. |
- Hörberg, Ulrica, 1968-
(författare)
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Att vårdas eller fostras. Det rättspsykiatriska vårdandet och traditionens grepp
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- To be sentenced to care in the forensic psychiatric services can be seen as one of the most comprehensive encroachments society can make on a person's life and being, as it entails a limitation of the individual's freedom but with no time limit. The aim of this dissertation is to describe caring in forensic psychiatry based on how it is experienced by those who perform the caring and by those are cared for in a maximum secure unit. A reflective lifeworld approach, based on phenomenological philosophy, has been applied. The data has been collected in interviews that have been analyzed by use of a meaning analysis searching for the essence of the phenomenon. The results of the research are presented in two empirical studies and a general structure based on the empirical findings. The dissertation also contains an excursus, a philosophical intermediate chapter containing further analysis of the results of the studies. The results show how the forensic psychiatric care is experienced as being non-caring by the patients with only small "pockets" of good care. Caring consists of corrective techniques that are unreflected and contradictory, where the conditions are determined by the caregivers and the ward culture. The correcting takes place through the modification of the patients' behaviour with the aim of the patients having to adapt themselves to the terms of the care provision. This care results in the patients trying, by use of different strategies, to adapt them-selves to the demands of the caregivers in order to gain privileges. At the same time the patients long to get away from the care system and are lacking real, meaningful and close relationships. To be the subject of care entails struggling against an approaching overwhelming sense of resignation and to care entails experiencing both power and powerlessness in performing the care. A destructive power struggle is being waged within forensic psychiatric care that suppresses the caring potential and true caring is thus elusive. The characteristics of forensic psychiatric care, based on the results of the research, are clarified in the dissertation's excursus. These include the corrective and disciplinary nature of forensic psychiatric care, its power and how this is materialized in care situations as well as the influence of tradition on current forensic psychiatric care in the light of the work of the French philosopher Michel Foucault. The dissertation shows that if the caring potential is to be able to be developed and form a caring nucleus for forensic psychiatric care then education levels need to be further developed. A caring culture and caring environment is needed where true caring can gain a foothold. In order for this to become a possibility the current caring culture and environment must be clarified, questioned and examined. The prevalent fundamental ideas in forensic psychiatric care have to be "jeopardized" and challenged by new scientifically based ideas on what constitutes true caring in this context.
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| 10. |
- Johansson, Annelie, 1973-
(författare)
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När kroppen sviker : -en livsvärldsstudie om kvinnors erfarenheter av hälsa, sjukdom och vård i samband med en hjärtinfarkt
- 2005
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis for a licentiate degree is a Caring Science lifeworld study the purpose of which is to describe women’s experiences of illness, health and care following a myocardial infarction. It consists of two studies (Papers I and II) which form the first part of a doctoral dissertation. Cardio-vascular disorders are a major public health problem today. Besides the impact these disorders have on public finances, a disease such as myocardial infarction entails suffering for the afflicted person. Current research indicates that women measure their health as lower than men following a myocardial infarction. There is still a lack of knowledge on how to understand women’s health process following a myocardial infarction, and how to provide them with the support needed to promote good health and well-being. Paper I explores women’s experiences of their lifeworld and body following a myocardial infarction. Paper II explores women’s experiences of the care and health process following a myocardial infarction, with a particular focus on their experience of participation. The method of reflective lifeworld research, based on phenomenological epistemology, is used to explore the meaning that is experienced in the lived world of the patient. This research finds that women describe that their lives come to a stand-still following a myocardial infarction. They perceive their bodies as having failed them, which entails existential uncertainty, meaning that the women no longer feel secure about their bodies or life, itself. Their suffering is difficult to understand, both for themselves and for those around them, and the women suffer in silence. Health-care professionals have the potential to promote health by supporting the women towards greater participation and independence in the health process. Participation, however, is not limited to concrete participation in care, but in offering health care based on women’s perspective of how their life situations changed following the illness. This will provide the women with the support they need to discover their own health promoting resources, and to become friends with their bodies and the life that follows a myocardial infarction.
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