Submitted by MARCIA ROVADOSCHI (marciar@unifra.br) on 2018-08-22T13:08:35Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_RoselainedosSantosFelix.pdf: 4923751 bytes, checksum: 97b12f80a780930245d6dbccffe6b309 (MD5) / Made available in DSpace on 2018-08-22T13:08:35Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_RoselainedosSantosFelix.pdf: 4923751 bytes, checksum: 97b12f80a780930245d6dbccffe6b309 (MD5) Previous issue date: 2017-05-22 / In the effort to improve, the quality of health care with emphasis on patient safety and organizational culture assessments many efforts have been put forth worldwide. One of the groups to be investigated consists of the same maternal and childcare that for the sake of make part of a special population, which requires a general and specific care, with the necessity for a multi-professional team action. Therefore, this study had the objective to evaluate the safety culture of the patient in a maternity ward from the perspective of the users and from the multi-professional team. For this purpose, a cross-sectional study was carried out in which data gathering occurred between the months of May and June 2016 at the maternity hospital of a large teaching hospital in the interior of the Rio Grande do Sul state, Brazil. The sample was consisted of 352 users (101 pregnant women and 251 postpartum women) and 62 staff members (25 nursing assistants and technicians, 15 residents, 14 nurses and 8 other professionals). A questionnaire previously validated with socio-demographic, both clinical and patient safety already used with the users and the Brazilian version of the Survey Hospital Survey on Patient Safety Culture, da Agency for Healthcare Research and Quality for professionals were the instruments utilized. All the work made in the elaboration of this essay followed all ethical aspects involving research with human beings. The data was analyzed through descriptive statistics (in absolute and relative frequencies) and also inferential, in which the chi-square test was applied to verify the associations between the patient's safety level, the events reported and the socio-demographic and clinical data that possessed the International goals of patient safety, respectively, in the category of health professionals and its users. It was considered a level of significance of α<0,05. The perception results of users about patient safety showed that the majority (60%) of the users were unaware of the issue, could not identify the risks related to care (82%), were satisfied with care (95%) and made suggestions in two categories: working processes (75%) and structure (10%). Among the associations performed, there was an association between age with the goal 4 of the correct procedures (p=0.03), number of pregnancies with the goals 2 of communication (p=0.03) and 3 related to medicine (p=0.01), type of delivery and Goal 2 (p=0.00), number of medical appointments and goal 1 of the correct identification of patients (p=0.01). With the basis on the evaluations of the dimensions from the instrument used with the professionals, no areas of positive force were identified, although organizational learning and continuous improvement; as well as expectations and actions of supervisors; openness to communication were located in the neutral area, and the others presented potential for improvement, with lower scores for management support dimensions and non-punishing responses to errors. The health team evaluated the degree of safety of the patient in the maternity ward as average (59.7%) and presented 15 suggestions to strengthen the safety culture of the patient in the maternity ward. The results suggest that users and health professionals identified week points of the patient safety culture in the maternity ward. To improve this scenario, some products were elaborated among those a folder and a Manual for the safety of the patient in the maternity ward with orientations for patients, relatives, companions and professionals. There are the necessity of changes to strengthen this culture and those are urgent and a priority, integrating a diversity of organizational actions that compromise managers, professionals and users in the promotion of a safe maternity ward. / Muitos esforços têm sido desenvolvidos em âmbito mundial para melhorar a qualidade da assistência à saúde com ênfase na segurança do paciente e em avaliações da cultura organizacional. Um dos grupos a serem investigados compreende o da atenção materno-infantil, por constituir uma população especial, que exige cuidados gerais e específicos, com a necessidade de uma atuação multiprofissional. Portanto, o presente estudo teve como objetivo avaliar a cultura de segurança do paciente em uma maternidade na perspectiva das usuárias e da equipe multiprofissional. Para isso, foi realizado um estudo transversal, com a coleta dos dados entre os meses de maio e junho de 2016, na maternidade de um hospital de ensino, de grande porte, do interior do estado do Rio Grande do Sul, Brasil. A amostra foi composta por 352 usuárias (101 gestantes e 251 puérperas) e 62 profissionais da equipe (25 auxiliares e técnicos de enfermagem, 15 residentes, 14 enfermeiros e, 8 outros profissionais de nível superior). Os instrumentos utilizados foram um questionário previamente validado com dados sociodemográficos, clínicos e de segurança do paciente utilizado com as usuárias e a versão brasileira do questionário Hospital Survey on Patient Safety Culture, da Agency for Healthcare Research and Quality para os profissionais. O trabalho seguiu todos os aspectos éticos envolvendo pesquisa com seres humanos. Os dados foram analisados por meio de estatística descritiva (frequências absolutas e relativas) e inferencial, na qual o teste qui-quadrado foi aplicado para verificar as associações entre o grau de segurança do paciente, os eventos notificados e os dados sociodemográficos e clínicos com as metas internacionais de segurança do paciente, respectivamente, na categoria dos profissionais de saúde e usuárias. Considerou-se um nível de significância de α<0,05. Os resultados da percepção das usuárias sobre segurança do paciente apontaram que a maioria (60%) das usuárias desconhece o tema, não conseguem identificar os riscos relacionados à assistência (82%), estão satisfeitas com o atendimento (95%) e, realizaram sugestões em duas categorias: processos de trabalho (75%) e estrutura (10%). Dentre as associações realizadas, houve associação entre idade com a meta 4 dos procedimentos corretos (p=0,03), número de gestações com a meta 2 da comunicação (p=0,03) e 3 sobre medicamentos (p=0,01), tipo de parto e a meta 2 (p=0,00), número de consultas e a meta 1 da identificação correta dos pacientes (p=0,01). Com base nas avaliações das dimensões do instrumento utilizado com os profissionais não foram identificadas áreas de força positiva, mas o aprendizado organizacional e melhoria contínua; expectativa e ações dos supervisores e; abertura para comunicação localizaram-se na área neutra, sendo que as demais apresentaram potencial de melhoria, com menores escores para as dimensões apoio da gestão e respostas não punitivas aos erros. A equipe de saúde avaliou o grau de segurança do paciente na maternidade como regular (59,7%) e apresentou 15 sugestões para fortalecer a cultura de segurança do paciente na maternidade. Os resultados sugerem que usuárias e profissionais identificaram fragilidades da cultura de segurança do paciente na maternidade. Para melhorar este cenário, os produtos elaborados foram um folder e um Manual para a segurança do paciente na maternidade com orientações para pacientes, familiares, acompanhantes e profissionais. Mudanças para fortalecer esta cultura são inadiáveis e prioritárias, integrando uma diversidade de ações organizacionais que comprometam gestores, profissionais e usuárias na promoção da maternidade segura. Palavras-chave: Cultura

Submitted by Sandra Denise de Oliveira Clinco (sandraclinco@gvmail.br) on 2013-04-01T17:45:41Z No. of bitstreams: 1 Tese Sandra Clinco versao definitiva abril2013.pdf: 419339 bytes, checksum: 257e9c5fd66cef45c69e044ee8335123 (MD5) / Approved for entry into archive by Suzinei Teles Garcia Garcia (suzinei.garcia@fgv.br) on 2013-04-01T17:54:16Z (GMT) No. of bitstreams: 1 Tese Sandra Clinco versao definitiva abril2013.pdf: 419339 bytes, checksum: 257e9c5fd66cef45c69e044ee8335123 (MD5) / Made available in DSpace on 2013-04-01T17:58:01Z (GMT). No. of bitstreams: 1 Tese Sandra Clinco versao definitiva abril2013.pdf: 419339 bytes, checksum: 257e9c5fd66cef45c69e044ee8335123 (MD5) Previous issue date: 2013-02-28 / A participação do paciente no cuidado é uma importante ferramenta para melhoria dos processos em uma organização hospitalar, pois aumenta a segurança do paciente. Este estudo teve como objetivo analisar se o paciente participa de seu cuidado. Esta análise foi feita por meio de entrevistas estruturadas com 243 pacientes internados em quatro hospitais com certificado de qualidade da Grande São Paulo e com a aplicação de questionário com perguntas abertas a três gestores destas organizações. Os resultados demonstram que os pacientes tem alta participação no cuidado, porém 17,3% dos pacientes referem que participaram do cuidado menos do que queriam e 43,6% não sabiam o nome do médico responsável pelo seu tratamento. Os gestores hospitalares reconhecem que a participação do paciente é importante, mas não há ações proativas efetivas nestas organizações hospitalares para identificar as necessidades dos pacientes. / The patient participation in care is an important tool for improving processes in a hospital organization, it increases patient safety. This study aimed to assess if the patient participates in their care. This analysis was done by structured interviews with 243 patients in four hospitals with quality certificate at the greater São Paulo region and with a questionnaire with open questions to three managers of these organizations. The results demonstrate that patients have high participation in care, but 17,3% of patients report that their participated care was less what they wanted and 43,6% did not know the name of the their attending physician. The hospital managers recognize that the participation of the patient is important, but no effective proactive actions were taken in these hospital organizations to identify the patients’ needs.

Introduction and background Recruitment to cancer clinical trials needs to be improved, as does patient understanding about clinical trials, to enable patients to make an informed choice about whether or not to take part. The main reason that clinically eligible patients do not take part in clinical trials is because they refuse; poor understanding of the research has been associated with patient refusal. Audiovisual patient information (AVPI) has been shown to improve knowledge/understanding in various areas of practice but there is limited information about its effect in the cancer clinical trial setting, particularly in relation to recruitment rates. Understanding the research is necessary for informed consent, and it was hypothesised that if patient understanding about clinical trials was increased with AVPI, then this could result in a reduction in the number of patients refusing clinical trials, and therefore provide an ethical approach to improving recruitment. This study aimed to test the impact of an audiovisual patient information intervention on recruitment to randomised cancer clinical trials (refusal rates), patient understanding of the information given, and levels of anxiety. Reasons for patients’ decisions about trial participation were also assessed. Method An AVPI intervention was developed that aimed to address the common misconceptions associated with randomisation and clinical equipoise, as well as improve patient understanding generally of randomised cancer trials, and of other core clinical trial informational requirements, such as voluntariness. Patients were randomised to receive either AVPI in addition to the standard trial-specific written information, or the written information alone. A new questionnaire was developed to assess patient understanding (also referred to as knowledge) in the randomised trial setting and, following testing with patients and research nurses, this was shown to be reliable and valid. Patients completed self-report questionnaires to assess their understanding (new knowledge questionnaire) and anxiety (Spielberger State-Trait Anxiety Inventory), at baseline and after they had made their decision about clinical trial entry, when their perceptions of the intervention, as well as factors contributing to their decision were also determined (this tool incorporated Jenkins and Fallowfield’s (2005) questionnaire which assessed reasons for accepting and declining randomised cancer trials). Results A total of 173 patients with breast cancer (65%), colorectal cancer (32%) and lung cancer (3%) were entered into the main study. The median age was 60 (range 37-92 years). There was no difference in clinical trial recruitment rates between the two groups: 72.1% in the AVPI group and 75.9% in the standard information group. The estimated odds ratio for refusal (intervention/no intervention) was 1.19 (95% ci 0.55-2.58, p=0.661). Knowledge scores increased more in the intervention group compared to the standard group (U= 2029, p=0.0072). The change in anxiety score between the arms was also statistically significant (p=0.011) with anxiety improving in the intervention arm more than in the no-intervention arm. The estimated difference in the median anxiety change score between the groups is –4.6 (95% ci –7.0 to –2.0). Clinical trial entry was not influenced by tumour type, stage of cancer, age, educational qualifications or previous research experience, however, there was a modest association with deprivation status (p=0.046) where more affluent patients were the least likely to consent to a trial. Educational qualifications and stage of cancer were independently associated with knowledge: patients who were better educated had higher levels of knowledge about randomised trials, and patients who had limited stage of cancer had higher baseline knowledge than patients with advanced cancer. Acceptability of the intervention was high with 93% of those who watched it finding it useful, and 42% stating that it made them want to take part in the clinical trial. Personal benefit and altruism were key motivating factors for clinical trial participation, with reasons for refusal being less clear. Discussion and conclusions Although the potential for AVPI to increase clinical trial recruitment rates was highlighted in the literature, in this study, AVPI was not shown to have any effect on refusal rates to randomised cancer trials. However, by improving patient understanding prior to decision making, AVPI was shown to be a useful addition to the consent process for randomised cancer trials. AVPI addresses the fundamental ethical challenges of informed consent by improving patient understanding, and supports the ethical framework integral to Faden and Beauchamp’s (1986) theory of informed consent. The new knowledge questionnaire was shown to be a sensitive and effective instrument for measuring understanding of randomised clinical trials in the cancer setting, although it would benefit from further testing. The AVPI appears to reduce anxiety at the decision making time point and has been shown to be an acceptable medium for patients. This study confirms existing findings from studies assessing factors affecting decision making, with personal benefit and altruism being key motivating factors, and reasons for refusal being less clear. The need for further qualitative work in this area is highlighted to gain a deeper understanding of what is important to patients, in terms of why they refuse clinical trial participation. Implications for practice and further research Several implications for practice have been identified, including using AVPI as part of the standard information package for patients considering randomised cancer trials, and focussing on patient and staff education in this area. The knowledge questionnaire could be introduced to routine practice as a tool to determine patient understanding prior to decision making, allowing clinicians the opportunity to correct any misconceptions prior to consent. Further research focussing on AVPI specific to individual trials would be helpful, to determine if a more customised approach would be of benefit in terms of clinical trial recruitment. The importance of studying other aspects of the consent process such as the interaction between the clinician and the patient, in addition to more detailed exploration of the factors affecting patients’ decisions were highlighted.

Bakgrund: Patientinvolvering och patientdelaktighet inom vården har blivit allt mer aktuellt de senaste åren. En metod för patientdelaktighet som testats framför allt inom somatisk vård är Experience-Based Co-Design (EBCD). Lokalt problem: Verksamheten har strukturer för att fånga erfarenheter från patienter, men det saknas strukturer för att fånga närståendes och personals erfarenheter. Det saknas ett forum där patienter, närstående och personal kan mötas och tillsammans arbeta med förbättringar. Syfte: För förbättringsarbetet, testa metoder från EBCD inom kontexten psykiatrisk heldygnsvård. För studien, beskriva deltagares erfarenheter av att involveras i förbättringsarbete utifrån EBCD, samt att belysa vad som gör det svårt att engagera patienter i förbättringsarbete. Metod: Övergripande struktur för förbättringsarbetet är Nolans förbättringsmodell och PDSA. Studien utgörs av kvalitativ innehållsanalys av två semistrukturerade fokusgruppsintervjuer. Interventioner: Metoder från EBCD har anpassats efter kontexten och testats. Resultat: Att delta i förbättringsarbete utifrån EBCD har varit uppskattat och utvecklande. Svårigheter har framför allt varit rekrytering av patienter. Slutsatser: EBCD går att använda inom psykiatrisk heldygnsvård, modifieringar är nödvändiga. Vilka och hur behöver studeras vidare. EBCD påverkar individen och organisationen. För att uppnå ett önskat utfall och för att engagera deltagare behöver vissa förutsättningar uppfyllas vad gäller strukturer och maktutjämning mellan patienter, närstående och personal. / Background: Patient involvement and patient participation within health care has been more and more important the last years. One method for patient involvement that has been tested (mostly in somatic care) is Experience-Based Co-Design (EBCD).  Local problem: The organization has structures to gather experiences from patients, but there is no structure to gather experiences from dependants or staff. There is no forum for patients, dependants and staff to meet and together work with improvement. Aim: For the Quality Improvement project (QIP) try methods from EBCD in the context of psychiatric in-patient care. For the study of the QIP describe participant’s experiences of being part of a QIP based on EBCD, and highlight what makes it difficult to engage patients in QIP. Method: The main structure for the QIP is Nolan’s model of change and PDSA. The study consists of a qualitative content analysis based on two semi-structured focus group interviews. Interventions: Methods from EBCD has been adjusted according to the context and then tested. Result: To participate in a QIP based on EBCD has been appreciated and developing. Difficulties have above all been the recruiting of patients. Conclusions: EBCD is possible to use in psychiatric in-patient care, modifications are necessary. Which modifications and how needs to be examined further. EBCD affects both the individual and the organization. To achieve asked goals and to engage patients there are some conditions that need to be fulfilled according to structures and equalisation of power between patients, dependants and staff.

Bakgrund: Överrapportering vid skiftbyte är en essentiell del av sjuksköterskans kliniska arbete, trots detta råder inte konsensus om vilken rapporteringsmetod som är bästa praxis. I takt med en större personcentrering av vården står patientens rätt till delaktighet och medbestämmande i större fokus, och bedsiderapportering har vuxit fram som ett alternativ till den traditionella rapporten. Syfte: Att belysa hur sjuksköterskor och vuxna patienter i den somatiska slutenvården beskriver sin upplevelse av bedsiderapportering. Metod: Denna litteraturöversikt genomfördes som en förenklad metasyntes där dataanalysen baserades på kvalitativ innehållsanalytisk teknik. Resultat: Tre huvudteman framkom gällande patienters upplevelse av bedsiderapportering: patientmedverkan, bättre vårdupplevelse samt möjliga hinder. Ytterligare tre huvudteman framkom för sjuksköterskors upplevelser: upplevda fördelar, möjliga hinder och förutsättningar för bedsiderapportering. Både patienter och sjuksköterskor beskrev positiva upplevelser av bedsiderapportering med den främsta fördelen att patienten blev mer delaktig i vården. Patienter beskrev en ökad trygghetskänsla och ett tillgodosett informationsbehov. Sjuksköterskor beskrev hur patientsäkerheten förbättrades och prioriteringar underlättades av bedsiderapportering. Oro kring sekretess och känslig information lyftes av både sjuksköterskor och patienter. Slutsats: Bedsiderapportering kan utgöra ett värdefullt verktyg i en mer personcentrerad vård, men att ytterligare kunskap behövs kring hantering av sekretessen. / Background: Shift reporting is an essential part of the nurse’s clinical work, despite this there is no consensus about what constitutes best practice. As personcentredness is becoming more important, more focus is on the patients’ right to participation and shared decision-making, and bedside reporting has become an alternative to the traditional shift report. Aim: To illustrate how nurses and adult inpatients within the somatic care describe their experience of bedside handover. Method: This literature review was conducted through a simplified meta-synthesis approach based on qualitative content analysis as a tool for the analysis of data. Results: Three main themes regarding patients’ experiences of bedside handover emerged: patient participation, improved care experience and possible barriers. Three additional main themes regarding nurses’ experiences emerged: perceived advantages, possible barriers and enabling factors for bedside handover. Both patients and nurses reported positive experiences of bedside handover, with the foremost advantage being the patients’ involvement in their care. Patients described an increased feeling of safety and that their needs of information were met. Nurses described how patient safety was improved and how prioritization was facilitated. Both nurses and patients had concerns about confidentiality and sensitive information. Conclusion: Bedside handover can be used as a valuable tool in the work towards a more person centred care, but there is a need for further knowledge about how confidentiality can be managed.

Bakgrund: Vi blir idag allt äldre. Ett ökande antal äldre med komplexa vårdbehov kräver en samordnad vård utifrån ett helhetsperspektiv med patienten som person i centrum. En samordnad vårdplanering genomförs på sjukhuset före utskrivning för att samordna hälso- och sjukvård från sjukhus, primärvård och kommunal vård. Dessa vårdplaneringar utförs idag ofta via videomöte. För att upprätthålla en personcentrerad vård och främja en trygg och säker hemgång, behöver vårdplaneringen genomföras på ett sådant sätt att den äldre upplever delaktighet och därmed kan påverka beslut kring sin egen vård och hälsa. Syfte: Syftet med studien var att beskriva samordnad vårdplanering via videomöte ur den äldre personens och närståendes perspektiv. Metod: En induktiv kvalitativ forskningsansats användes genom åtta personliga ostrukturerade intervjuer. Ett strategiskt urval gjordes som resulterade i fyra äldre personer, Md=79 år, (70-83), samt fyra närstående, Md=54 år, (45-58). Inklusionskriterier var erfarenhet av vårdplanering via videomöte och för de äldre en ålder på minst 70 år. Materialet analyserades med kvalitativ innehållsanalys. Resultat: Den äldre personens och närståendes upplevelse av vårdplanering via videomöte kan beskrivas av temat att befinna sig i ett utanförskap. Detta baseras på tre kategorier utifrån upplevelse av opersonlighet, meningslöshet samt bristande delaktighet. Otillräcklig förberedelse eller information kan skapa en känsla av utanförskap som riskerar hindra möjligheten till delaktighet, inflytande och medbestämmande i vården. Slutsats: Samordnad vårdplanering via videomöte kan möjligen bli en tillfredsställande mötesform även för äldre. Flera utmaningar och svårigheter måste dock hanteras när det gäller möjlighet till delaktighet och medbestämmande för den äldre personen och närstående i vårdplanering via videomöte. Utan tidigare erfarenhet av videomöten kan kommunikation via en skärm vara en obekant upplevelse. Ett välplanerat videomöte med förberedd och insatt vårdpersonal samt en informerad och trygg patient och närstående är förutsättningar som behöver uppfyllas. / Background: We are becoming older than ever before. A growing number of elderly patients with complex caring needs require coordinated care from a holistic perspective with the patient as a person at the center. A coordinated care planning is conducted in the hospital before discharge in order to coordinate the health care needed from hospital, primary care services and municipal care. Today, these care planning's are often performed via video conference. In order to maintain a person-centered care and provide a safe and secure return to home, care planning need to be carried out in such a way that the elderly person may experience patient participation and thus can influence decisions on their own care and health. Aim: The aim of the study was to describe coordinated care planning via video conference from the elderly person's and next of kin's perspective. Method: An inductive qualitative research approach was used through eight personal unstructured interviews. A purposive sampling was conducted which resulted in a sample of four elderly persons, Md=79 years, (70-83) and four next of kin, Md=54 years, (45-58). Inclusion criteria were experience of care planning via video conference and for the elderly an age of at least 70 years. The data was analyzed with qualitative content analysis. Result: The older person's and the next of kin's experience of care planning via video conference can be described by the theme of being in an alienation. This is derived from three categories based on experience of impersonality, futility and a lack of participation. Insufficient preparation or information may create a feeling of alienation that can hinder the possibility of patient participation, influence and codetermination in the care. Conclusion: Coordinated care planning via video conference may become an adequate meeting form even for the elderly. However, several challenges and difficulties need to be addressed concerning patient participation and codetermination in care planning via video conference. Without previous experience of video conferencing, communicating via a screen can be a strange experience for the elderly person. A well-planned video conference with prepared and trained healthcare personnel as well as an informed and safe patient and next of kin are prerequisites that need to be fulfilled.

Bakgrund: Den svenska hälso- och sjukvården eftersträvar att arbeta personcentrerat. En del i att arbeta personcentrerat är att patienten ska få vara delaktig. Att arbeta med patientdelaktighet i hemsjukvården kan vara utmanande eftersom sjuksköterskan har regler och rutiner att följa. Om inte patientdelaktighet främjas riskerar det att patientens vård inte blir personcentrerad och därmed möter den kommunala hemsjukvården inte lagstadgade krav. Syfte: Att belysa sjuksköterskans erfarenheter av att främja patientdelaktighet för att uppnå en personcentrerad vård inom kommunal hemsjukvård. Metod: En kvalitativ intervjustudie med induktiv design valdes för att svara på studiens syfte. Datamaterialet inhämtades genom åtta semistrukturerade intervjuer med fem distriktssköterskor och tre sjuksköterskor. Datamaterialet analyserades inspirerat av Graneheim och Lundmans kvalitativa innehållsanalys.   Resultat: Analysen resulterade i två huvudkategorier och åtta underkategorier.  Sjuksköterskorna beskrev hur de arbetar för att bjuda in patienten i mötet, det gjordes genom att skapa och upprätthålla ett förtroende i mötet med patienten, lyssna in patienten, samarbeta med patienten, delge information, ge tid för patienten och att se patientens resurser. Sjuksköterskorna lyfte organisationens betydelse, hur de hade lagar och riktlinjer att följa och hur samverkan skedde både med och utan patienten. Slutsats: Patienten ska få tillåtas vara en aktiv medskapare i sin vård. Det finns en förbättringspotential för hur vården ska arbeta med patientdelaktighet för att möta lagstadgade krav. Det finns en otydlighet om vad patientdelaktighet innebär och sjuksköterskorna behöver vägledning och stöd från organisationen. / Background: The Swedish health service strives to work person-centered. Part of working person-centered is that the patient should participate. Working with patient participation in home care can be challenging because the nurse has rules and guidelines to follow. Unless patient participation is promoted, there is a risk that the patient's care will not become person-centred and thus the municipal home care does not meet legal requirements. Aim: To highlight the nurses experience in promoting patient participation in achieving person-centered care in municipal home care.  Method: A qualitative interview study with inductive design was chosen to answer the purpose of the study. The data was obtained through eight semi-structured interviews from five district nurses and three nurses. The data was analysed inspired by Graneheim and Lundman's qualitative content analysis.   Results: The analysis resulted in two main categories and eight subcategories. The nurses described how they work to invite the patient into the meeting, it was done by creating and maintaining a trust in the meeting with the patient, listening to the patient, collaborating with the patient, sharing information, giving time for the patient and seeing the patient's resources. The nurses emphasized the importance of the organization, how they had laws and guidelines to follow and how collaboration took place both with and without the patient. Conclusion: The patient should be allowed to be an active co-creator in their care. There is potential for improvement in how healthcare should work with patient participation to meet legal requirements. There is a lack of clarity about what patient participation means and nurses need guidance and support from the organisation.

Bakgrund: Bedside-överrapportering är avsedd för att möjliggöra patienternas delaktighet och vara ett personcentrerat tillvägagångssätt där patienternas expertinformation tillvaratas. I tidigare forskning beskriver sjuksköterskorna patienterna som en oanvänd resurs i överrapporteringar (icke bedside). Dessutom erfar sjuksköterskorna tidsbrist och att rapporter var ofullständiga. Patienterna uppskattade i sin tur bedside-överrapportering eftersom de upplever en större kontroll och delaktighet. Dock erfars en utmaning kring känslig information och konfidentialitetsfrågor. Problem: Sjuksköterskorna har en central roll i att möjliggöra patienternas delaktighet och deras erfarenheter anses kunna bidra till en bättre förståelse för utmaningar och möjligheter i bedside-överrapportering. Syfte: Att skapa en kartläggning av sjuksköterskornas erfarenheter av bedside-överrapportering. Metod: Allmän litteraturöversikt för att skapa en översiktlig bild grundad i en analys av 10 artiklar. Resultat: Sjuksköterskorna erfor att patienterna blev mer delaktiga vid bedside-överrapportering och att personcentrerad vård främjades eftersom patienterna hamnade i fokus. Sjuksköterskorna beskrev även utmaningar i bedside-överrapporteringar i huruvida konfidentilitet och integritet röjdes samt avbrott och tidsbrist. Trots detta sågs även förbättringar som att överrapporteringarna erfors bli mer korrekt och komplett och kommunikationen ansågs förbättrad. Utöver detta upplevde sjuksköterskorna sig mer nöjda. Slutsats: Sjuksköterskorna uttryckte en förbättring i patientdelaktighet, personcentrering, kommunikation och rapportering. Dock fanns hinder i patientdelaktighet och problem gällande tidsaspekten och konfidentialitetsfrågor. / Background: Bedside handoff is a person-centred approach that aims to enable patient-participation and ensure the patients’ expert information is utilised. In earlier research nurses describe patients to be an unused resource. Furthermore, nurses find that lack of time and incomplete reports are problems in patient handoffs. Patients appreciate bedside handoffs because they feel more involved and in control. However, there is a perceived challenge concerning sensitive information and confidentiality issues. Problem: Nurses have a crucial role in enabling patient participation and their experiences are considered to help form a greater understanding of the challenges and possibilities relating to bedside handoffs. Purpose: To create an overview of nurses’ experiences of bedside handoff. Method: General literature review to create an overview founded in the analysis of 10 articles. Results: Nurses experienced that patients became more involved with bedside handoffs and that person-centred care was promoted because patients became the focus. Nurses also described challenges with bedside handoff in whether confidentiality and integrity were jeopardised. Moreover, challenges such as interruptions and lack of time were found. Despite this, improvements were also seen such as a more accurate and complete report, and improvements in communication. In addition, nurses felt more satisfied using bedside handoff. Conclusion: Nurses experienced an improvement in patient-participation, person-centred care, communication and in the report itself. However, there were barriers to patient-participation, time limits and confidentiality issues.

Bakgrund: Det finns idag tydliga signaler om att hälso- och sjukvården ska ge en personcentrerad vård till samhällets individer.  Det finns även en önskan att öka möjligheten för patienten att vara delaktig i sin vård. En personcentrerad vård kan ge möjlighet för patienten att bli medskapare och inte enbart mottagare av vård. Syftet: Förbättringsarbetets syfte var att öka patientens möjlighet till delaktighet genom att implementera patientberättelse och hälsoplan. Studiens syfte är att synliggöra medarbetarnas erfarenheter av att arbeta med patientberättelsen och hälsoplanen samt patientdelaktighet i vården.  Metod: Förbättringsarbetet genomfördes med stöd av Nolans förbättringsmodell samt kartläggning av enheten utfördes med hjälp av 5P. De idéer som testades var införande av patientberättelse och dokumenterad hälsoplan. Datainsamling till studien gjordes med intervjuer av sex medarbetare som analyserats med kvalitativ innehållsanalys.  Resultat: Andelen patienter som angav att de var delaktiga i den utsträckning de önskar i vården på avdelningen, ökade från 77% till 95% vilket kan ses som ett positiv effekt på patientdelaktighet. I den kvalitativa innehållsanalysen identifierades tre kategorier: patientens vård, kommunikation samt organisationen och arbetssätt, där både möjligheter och hinder kunde ses.  Slutsats: Personcentrerad vård ökar möjligheten för patienten att vara delaktig i sin vård på en akutkirurgisk vårdavdelning. / Background: There are clear signals that health care should provide person-centered care for the citizens. There is also a wish to increase the possibility for the patient to be involved in their care. The person-centered care can provide an opportunity for the patient to become co-creators and not only recipients of care. Purpose: The purpose of the improvement work was to increase the patient's opportunity for participation by implementing patient narrative and care plan. The purpose of the study is to make visible the employees' experience of working with the patient narrative and care plan to create patient participation.  Method: The improvement work was implemented with the support of Nolan's improvement model and 5P was used to assess the unit. The ideas tested were the introduction of a patient narrative and a documented care plan. Data collection for the study was conducted with interviews of six employees and analyzed with qualitative content analysis.  Results: The proportion of patients who felt that they had participated in the decisions regarding their care/treatment on the ward to the extent they wanted, increased from 77% to 95%, that can be seen as a positive effect on patient participation. The qualitative content analysis of interviews with employees was identified in three categories: the patient's care, knowledge/communication and organization/working methods where both facilitators and barriers could be seen. Conclusion: Person-centered care increases the possibility for the patient to participate in their care in an emergency surgical ward.

No description available.