The overall aim of this thesis was to investigate the patients’ and their relatives’ perceived participation in discharge planning after stroke and the patients’ health-related quality of life, depressive symptoms, performance of personal daily activities and social activities in connection with discharge. Another aim was to evaluate the psychometric assumptions of the SF-36 for Swedish stroke patients. Prospective, descriptive and cross-sectional designs were used to study all patients with stroke admitted to the stroke unit at a hospital in southern Sweden from October 1, 2003 to November 30, 2005 each with one close relative. The total sample consisted of 188 patients (mean age=74.0 years) and 152 relatives (mean age=60.1 years). Data were collected during interviews, 2-3 weeks after discharge. The results showed that less depressive symptoms, more outdoor activities and performance of interests are important variables that related to higher HRQoL. SF-36 functions well as a measure of health related quality of life in Swedish stroke patients, but the two summary scales have shortcomings. Compared to a Swedish normal population, scores on all scales/components of the SF-36 were lower among stroke patients especially in the middle-aged group. Most of the patients perceived that they received information, but fewer perceived participation in the planning of medical treatment and needs of care/service/rehabilitation and goal setting. The relatives perceived that they need more information and they perceived low participation in goal setting and needs assessment. The professionals seem to lack effective practices for involving patients and their relatives to perceive participation in discharge planning. It is essential to develop and to implement methods for discharge planning, including sharing information, needs assessment with goal setting that facilitate patients’ and relatives’ perceived participation. The results suggest that ICF can be used in goal setting and needs assessment in discharge planning after acute stroke.

The overall aim of the thesis was to describe patient−health-professional interactions in a hospital setting, with a specific focus on the surgical care unit. The thesis consists of four studies and includes both qualitative and quantitative studies. Content analysis and phenomenography were used in the qualitative studies; the quantitative study was an intervention study with a three-phase quasi-experimental design. The findings of study I showed that patient complaints to a local Patients’ Advisory Committee about negative interactions with health professionals most often concerned the perceived insufficiencies of information, respect, and empathy. The findings of study II showed that experiences of negative interactions with health professionals caused long-term consequences for individual patients and reduced patients’ confidence in upcoming consultations. The findings of the phenomenographic study (III) showed that surgical nurses understand an important part of their work in qualitatively different ways, which can be presented as a hierarchy of increasing complexity and comprehensiveness. In the most restricted understanding, surgical nurses focus on the work task, whereas in the others surgical nurses demonstrate increasing degrees of patient-centeredness. Finally, the results of study IV showed that an uncomplicated intervention that invited patients to express their daily questions and concerns in writing (using the ‘Tell-us card’) improved the patients’ perceptions of participation in their care in a surgical care unit. For further implementation of the Tell-us card to succeed, it needs to be prioritized and supported by leaders in ongoing quality improvement work. The value of a patient-focused interaction needs to be the subject of ongoing discussions in surgical care units. Patients’ stories of negative interactions could be used as a starting point for discussions in professional reflection sessions. It is important to discuss and become aware of different ways of understanding professional interactions and relationships with patients; these discussions could open up new areas of professional development. Providing patients an opportunity to ask their questions and express their concerns in writing, and using this information in the patient−health-professional interaction, could be an important step towards improved patient participation.

Diss. (sammanfattning) Linköping : Univ., 2002. / Härtill 5 uppsatser.

Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2007. / Source: Masters Abstracts International, Volume: 45-06, page: 2779. Adviser: Theresa Byrd. Includes bibliographical references.

Thesis (Ph.D. in Nursing) -- University of Colorado Denver, 2008. / Typescript. Includes bibliographical references (leaves 57-65). Free to UCD affiliates. Online version available via ProQuest Digital Dissertations;

Thesis (Ph.D. in Nursing) -- University of Colorado Denver, 2008. / Typescript. Includes bibliographical references (leaves 194-203). Free to UCD Anschutz Medical Campus. Online version available via ProQuest Digital Dissertations;

Bakgrund: Enligt Hälso- och sjukvårdslagen ställs kravet att vården ska bygga på respekt   för patientens integritet och självbestämmande. Trots detta visar studier att kravet inte uppnås, då patienter inte känner sig delaktiga i vården i den utsträckning de önskar. Studier visar på att det inom psykiatrin kan ta tid att införliva patientdelaktighet, då ett gammalt paternalistiskt synsätt på patienter lever kvar på sina håll. Inom ätstörningsvården beskrivs patientdelaktighet som en ledstjärna i behandlingen, men många människor med ätstörningar är svåra att engagera i behandling då de kan vara ambivalenta eller förnekar och inte ser allvaret i sjukdomen. I vårdsituationer uppstår ibland en konflikt mellan patientens rätt till delaktighet i sin egen vård och vad vårdpersonal tänker är det rätta och bästa för personen. Sjuksköterskan är den som står patienten närmast i omvårdnaden och har ett professionellt ansvar att göra patienten delaktig i sin behandling.  Syfte: Syftet med föreliggande studie är att undersöka hur sjuksköterskor beskriver  patientdelaktighet vid ätstörningsbehandling i psykiatrisk heldygnsvård. Metod: Studien är en kvalitativ studie med induktiv ansats där semistrukturerade intervjuer genomfördes med sex sjuksköterskor verksamma inom ätstörningsvården, från två olika heldygnsavdelningar i Stockholm. Intervjuerna spelades in och transkriberades för att sedan analyseras enligt kvalitativ innehållsanalys. Resultat: Studien resulterade; i sex huvudkategorier; Påverkan, Bemötande, Relation,  Organisation och vårdmiljö, Sjuksköterskans situation och Patientens situation med vardera tre underkategorier. Diskussion: Resultatet diskuterade utifrån Kari Martinsens omvårdnadsteori samt annan relevant forskning. / Background: The Swedish Health Care Act states that all care in Sweden should be based in the respect for patient integrity and self-determination. Despite     this, studies show that this requirement is not achieved, as patients do not feel involved in the care to the extent that they would wish. Studies have shown that in psychiatric care, it may take time to incorporate patient- participation, as healthcare professionals' view of patients in many places still tends to be characterized by paternalism. Patient participation is described to be a guiding principle in the treatment within eating disorder care, but as patients can often be either ambivalent to their illness, deny it or not take it seriously, their involvement in the treatment can be difficult to achieve. In situations of care giving, a conflict sometimes occurs between the patient’s right to participate in his or her own care, and the healthcare professional´s ideas of what is right and best for the person. The nurse is the one working the closest to the patient in nursing care and hence has a professional responsibility to make the patient involved in the treatment. Aim: The aim of the study is to investigate nurses’ descriptions of patient participation in eating disorders treatment in psychiatric inpatient care. Method: The study is a qualitative inductive study. Semi-structured interviews were conducted with six nurses from two different inpatient care wards specialized in treatment of eating disorders. The interviews were recorded and transcribed and then analyzed through qualitative content analysis. Results: The study resulted in six main categories; Influence, response,  Relationship, Organization and care environment, The nurse´s situation and The patient´s situation with each three respective subcategories.  Discussion: The results were discussed based on Kari Martinsens theory about nursing       and other relevant research.

The aim of this thesis was to acquire knowledge about patient participation in everyday life of persons with dementia living in SCUs in nursing homes. Data collection and analysis in studies I-III was carried out according to Grounded Theory. Data was collected by open non- participant observations during 51 hours, and conversations with 8 residents and 17 health care personnel (I), interviews carried out twice with 12 relatives (II) and 11 nursing personnel (III), and by a study specific questionnaire based on the findings from study I-II to 233 relatives (IV). Descriptive and non-parametric statistics were used (IV). Presence of nursing personnel in body, mind and morality was found to be the prerequisite for patient participation (I). This required personnel with high competence in dementia care, commitment to and interest in the resident, and continuity in their work (I, III). Wellbeing and dignity in the resident’s everyday life was found to be the most important goal, not necessarily a high level of patient participation (II-III). The level of participation had to be adjusted to the resident’s ability and wish to take part in decisions in the very moment. However, the level was often primarily adjusted to suit the personnel’s ideas about how to carry out daily care (I, III). Relatives had an important role in the participation process by interacting, and exchanging information, with the personnel. By forming a basis for individualised care in this way, relatives made a difference to the resident’s everyday life and contributed to their wellbeing and dignity (II-IV). The SCU’s context also affected patient participation (I-IV). Patient participation must be given attention by leaders and be prioritised in dementia care. Nursing personnel can enhance patient participation by promoting relatives’ partaking in the participation process, as this has potential for further contributing to quality of care.

Background Recent conflicts have seen an increase in trauma related military amputees who incur complex injuries which result in varied residual limbs. In many cases these amputees have been provided with state of the art (SOTA) components with the expectation that they will transfer into NHS care after military discharge. However, there is a lack of knowledge around how prosthetic prescriptions are made in both the MOD and NHS, including patient involvement. It is important to explore prosthetic prescription decisions to enhance the quality, consistency and equity of care delivery for trauma amputees. This thesis explores decision making in prosthetic care for trauma amputees in the UK during this period of change. Aims To explore aspects of prosthetic care provision in the UK including clinical decision making, patient experience and the transition of prosthetic care from the MOD to the NHS. Design An exploratory qualitative project informed by decision making and patient involvement theory. Semi-structured interviews were carried out with nineteen clinical staff involved in prosthetic provision, six civilian and five veteran trauma amputees. Thematic analysis was used to analyse the data. Findings Prosthetists used a wide range of factors in making prescription decisions, including physical characteristics, patients’ goals, and predicted activity levels. Prescription decision making varied depending on the prosthetists’ level of experience and the different ‘cues’ identified. In some cases there was a lack of transparency about drivers for the prescription choice. Prescription decisions are influenced by long term relationships between prosthetist and patient, allowing a trial and error approach with increasing patient involvement over time. Patient experiences of their trauma amputation influenced their approach to rehabilitation. Patients reported wanting different levels of involvement in their prosthetic care, however, communication was essential for all. Veteran amputees benefited from peer support opportunities which NHS services were less conducive to. However, NHS amputees were more likely to have been ‘involved’ in care decisions. The expectations that MOD patients had of inferior care in the NHS were not realised in the majority of veteran cases. Recommendations Research is needed to support prosthetists’ decisions to become more consistent and transparent. The NHS should consider introducing a peer support model for trauma patients, and particularly in the early stages of rehabilitation.

Bakgrund: Överrapportering mellan sjuksköterskor vid skiftbyte är en stor och viktig del av sjuksköterskans arbete, och dess innehåll påverkar det resterade arbetsskiftets sysslor. Rapporteringen kan ske på flertalet sätt, exempelvis traditionell rapportering som sker avsides från patienten, eller så kallad bedsiderapportering som sker i patientsalen tillsammans med patienten. Syfte: Denna litteraturstudies syfte var att undersöka evidensen för vilket av de två mest frekvent använda rapporteringssätten som är att föredra: traditionell rapportering eller bedsiderapportering. Vid jämförelsen mellan de båda fanns både sjuksköterskans uppfattning samt patientens uppfattning i åtanke. Metod: En litteraturöversikt utfördes. 12 originalartiklar valdes från databaser för vetenskapliga artiklar, CINAHL och Pubmed. Dessa lästes, analyserades och ledde fram till framställandet av fem resultatkategorier. Hildegard E. Peplau och hennes relationsteori kring omvårdnad bidrog som teoretiskt ramverk. Resultat: Fem teman identifierades ur studiens artiklar: främjande av relation mellan patient och sjuksköterska, ökad vårdsäkerhet för patienterna, involvering av patienten i vården, tidsåtgång för rapportprocessen samt påverkan på patientsekretessen. Resultatet visar att bedsiderapportering föredras av både patient och sjuksköterska, dock gärna en modifierad sådan där känslig information delges utom hörhåll för att bevara sekretessen. Slutsats: Bedsiderapportering föredras av både sjuksköterskor och patienter och är ett steg i rätt riktning mot en patientcentrerad vård. Trots att studier gjorts som bevisar detta är bedsiderapportering inte standard inom vården, något som bör ändras genom fortsatta studier för en säkrare och mer delaktig vård för patienter och ett bättre och effektivare arbetssätt för sjuksköterskor. / Background: Change of shift report between nurses is a big and important part of a nurse’s tasks, and its content and quality affects the coming shift’s tasks. The change of shift report can be carried out in multiple ways, for example traditional report which is conducted away from the patient, or bedside report which is located in the patient’s room with the patient. Purpose: The purpose of this literature review was to investigate the evidence for which of the two most commonly used methods of report is preferable: traditional report or bedside report. The comparison between the two methods of reporting addressed both the nurse’s opinion as well as the patient’s. Methods: The method used was literature review. 12 original articles were selected from databases for scientific articles, CINAHL and Pubmed. They were read and analyzed and resulted in five themes of results. Hildegard E. Peplau and her theory about relations in caring contributed as a theoretical framework. Results: Five themes were identified in the articles of the review: promoting of relationship between patient and nurse, safer care for patients, involving patient in care, time used for report and impact on patient’s confidentiality. The results showed that bedside report is preferred by both the patient and the nurse, preferably a modified version where sensitive information is handled away from the patient to keep the patient’s confidentiality. Conclusion: Bedside report is preferred by both nurses and patients and is a step towards a more patient centered care. Despite previous studies having shown this same result, bedside report is not yet implemented as standard report within the health care system. The conclusion of this review is that this should change and continuous studies should be conducted with an aim of safer care for patients with more patient participation, as well as better and more efficient way of work for nurses.