Från koja till plan

This thesis concerns questions regarding how children’s perspectives on the outdoor environment can be approached in a planning context. Attention is drawn to the general understanding of childhood and the definition of outdoor environment as variables in different planning contexts. Together these variables define in which way children become visible in the planning context. Children’s participation is emphasized in contemporary planning. This thesis argues that understanding and insights concerning children’s experiences and understanding of their own places can create complementary lines of communication. The first article provides the empirical and methodological point of departure. Through walkabouts with children, questions are developed concerning children’s use and experiences of outdoor environments. These questions are compared and related to problems, insights and experiences that planners have concerning environments for children. Parts of two perspectives are described in order to elucidate some of the problems that can arise due to differences between a child’s perspective and a planner’s perspective. In the second article children’s own places is the pivot. Through in depth studies of children’s dens it is shown that finding a suitable place, collecting, sorting and manipulating with environment and accessible materials are crucial parts of starting a den making process and appropriating a place as one’s own. Specific examples are put forward which show the close relationship between children’s experience and understanding of the outdoor environment and their construction and design of dens. Children’s dens are used to exemplify and clarify the difference between children’s perspectives and planner’s perspectives. The last article is concerned with the theoretical and practical analysis of these questions. Through interviews, studies of planning documents and reflections on my own planning experience an analysis is made of the importance of maps and plans as tools in the planning process. It is argued that the bias of these tools emphasizes and reinforces the visual point of departure to the physical environment and outdoor places, while children’s multi-sensuous and acting oriented point of departure is difficult to handle and process in maps and plans. A practical contribution is suggested on how to improve insights and understanding of children’s perspectives in planning contexts

Förhållningssätt och kommunikation i mötet med personer med demenssjukdom : utvärdering av ett träningsprogram med validationsmetoden

Communication difficulties among residents with dementia disease living in nursing homes may complicate care situations. These residents can have difficulties describing how they experience their everyday lives, which can lead to withdrawal, social isolation, or feelings of homelessness. Research indicates that nurses involved in dementia care experience communication as difficult and challenging. The validation method developed by Feil is held to facilitate communication through emphatic and confirmatory approaches. Scientific reviews show insufficient evidence for recommending the use of the method, in spite of this the method is used in dementia care. Evaluations of the validation method have primarily focused on the residents’ perspective, and reports on nurses’ experiences of the validation method are sparse. The overall aim for this thesis was to evaluate Feils’ validation method by describing nurses’ experiences and skills in communication observed during implementation of a training programme. Twelve nurses participated in the validation method training programme that included 10 days of theoretical training with supervision about once a month, and practical training integrated in everyday work. During practical training nurses had conversation with 3 residents each 2-3 times a week, and videotaped one conversation per month. Methods: The design is based on naturalistic scientific approach. Data were collected with interviews (I, II) and a questionnaire (II) before and after the programme, and videotaped conversations during the programme (III, IV). An interview was conducted as a comparison with nurses from another nursing home, who had long experiences of using the validation method (I). The result showed that nurses improved their communication and had closer relationships with residents with dementia disease after validation method training, in accordance with nurses with long experiences (I). The training strengthened the nurses, but also posed an extra strain on them. Even though the nurses described an extra strain on the entire nursing staff, this was not reflected in the results from the questionnaire about the work climate (II). Videotaped one-to-one conversations between nurses and residents showed that the nurses developed their approaches and communication skills, although to different degrees. An overall pattern revealed nurses’ movements within and between various paths when improving their communication skills (III). The findings were in congruence with the nurses described experiences (I). In videotaped conversations from the end of the programme, the residents had the possibilities to use their remaining communication abilities and to communicate what was currently on their mind (IV). This may be related to the development of the nurses’ communication skills during the programme. Conclusions of this thesis were that the nurses developed their skills in caring approach and communication when communicating with residents with dementia disease, which gave these residents possibilities to communicate according to their abilities. In order to integrate new knowledge about communication the results showed that it was necessary to combine theoretical and practical training with supervision and reflection. To provide nursing staff with this type of training could be seen as an investment for nursing homes, an opportunity to increase job satisfaction for nurses and to increase social community for residents

När det oväntade skett- en metod att stödja andlighet hos anhöriga vid oväntade dödsfall

Syfte med detta examensarbete är att utveckla en resursförstärkande arbetsmetod som kan användas mångprofessionellt inom social- och hälsovården för att stödja andliga behov hos vuxna anhöriga vid plötsliga oväntade dödsfall. Frågeställningarna för arbetet lyder: Vilka andliga behov har vuxna anhöriga vid oväntade dödsfall? Hur kan professionella inom social- och hälsovården stödja vuxna anhörigas andliga behov vid kris eller sorg förorsakade av oväntade dödsfall? Examensarbetet skrivs inom ramen för projektet ”Andlighet, spiritualitet och livsfrågor” vid Yrkeshögskolan Novia i Åbo. Metoden baserar sig på en kvalitativ litteraturöversikt med innehållsanalys som analysmetod. Resultatet av innehållsanalysen visar att professionella med hjälp av kommunikation kan stödja andliga behov som kan uppstå hos anhöriga vid oväntade dödsfall. Kommunikationen består både av samtal och bemötande. Samtal bör möjliggöras genom att professionella skapar rum och tillfällen där anhöriga får hjälp att integrera det oväntade dödsfallet i sin livsberättelse. För att ta till tals svåra tankar och känslor krävs det mod av professionella. I bemötandet är adekvat information, äkta närvaro, lyhördhet och ett empatiskt förhållningssätt viktiga. Resultatet utmynnar i en resursförstärkande metod som kan användas av professionella inom social- och hälsovården för att stödja andliga behov hos anhöriga vid oväntade dödsfall. Metoden tar fasta på den anhörigas egna behov och resurser samt förebygger ohälsa genom tidigt ingripande och stödjande uppföljning.Opinnäytetyön tavoitteena on kehittää voimavaroja vahvistava työmenetelmä, jolla tarjotaan hengellistä tukea omaiselle, joka on kohdannut odottamattoman kuoleman lähipiirissään. Työmenetelmä soveltuu käytettäväksi moniammatillisesti sosiaali- ja terveydenhuollossa. Työn kysymyksenasetteluna on: Mitkä ovat aikuisten omaisten hengelliset tarpeet yllättävässä kuolemassa? Miten sosiaali- ja terveydenhuollon ammattilainen voi tukea aikuisten omaisten hengellisiä tarpeita odottamattoman kuoleman aiheuttamassa kriisi- tai surutyössä? Opinnäytetyö on osa Turun Yrkeshösgskolan Novian hanketta ”Andlighet, spiritualitet och livsfrågor”. Tutkimusmenetelmä perustuu kvalitatiiviseen kirjallisuuskatsaukseen, jossa analyysimenetelmänä on sisällönanalyysi. Sisällönanalyysin tulokset osoittavat, että ammattilainen voi tukea äkillisessä kuolemantapauksessa esille tulevia omaisten hengellisiä tarpeita kommunikaation avulla. Kommunikaatio koostuu sekä keskustelusta että kohtaamisesta. Keskustelu pitäisi toteutua niin, että ammattilainen luo tilaa ja aikaa sille, että omaista autetaan sisällyttämään odottamaton kuolema hänen elämäntarinaansa. Vaikeiden ajatusten ja tunteiden esiin nostaminen vaatii ammattilaiselta rohkeutta. Täsmällinen tieto, aito läsnäolo, kuuntelu ja empaattinen lähestymistapa ovat tärkeitä kohtaamisessa omaisten kanssa. Tuloksena on voimavaroja vahvistava menetelmä, jota sosiaali- ja terveydenhuollon ammattilaiset voivat käyttää työssään tukeakseen omaisen hengellistä tarvetta kohdatessaan läheisen odottamattoman kuoleman kohdatessa. Menetelmä perustuu omaisen omiin tarpeisiin ja voimavaroihin ja sillä ennaltaehkäistään huonoa terveyttä aikaisen puuttumisen ja tukea tarjoavan seurannan avulla.The purpose of this Bachelor´s thesis is to develop a resource promoting work method that can be of use for multi-professionals in social- and healthcare services. This thesis is part of a larger project about spirituality and existential questions, entitled ”Andlighet, spiritualitet och livsfrågor” within the Novia University and Applied Sciences in Turku. In this thesis there are two formulated questions that leads the work: Which spiritual needs do relatives have at unexpected death? How can professionals in the social- and healthcare sector support relatives spiritual needs in a crisis or grief caused by unexpected deaths? The research method is a qualitative literature review with content analysis. In the theoretical part it is described different methods that are already in use as a support to relatives who lost a close person in an unexpected death. The results of this thesis are that professional help of communication can support the spiritual needs that may appear in families where there have been unexpected deaths. The communication consists of both dialogue and encounter with professionals in the social- and healthcare service. The dialogue should be made possible by the professionals by creating room and time where the families are guided to make the unexpected death in to their life story. To take their say of difficult thoughts and feelings, the professional needs courage. For the encounter with relatives adequate information, an authentic presence, responsiveness and an empathetic approach is important. The result concludes a resource promoting method that is to be used in order to support the spiritual needs of relatives who have experienced sudden and unexpected deaths. The method relies on the family´s own needs and resources and prevent disease through supportive follow-up