Objective: To explore differences between conventional medicine (COM) and complementary and alternative medicine (CAM) regarding the attitude toward and the perceived use of shared decisionmaking (SDM) from the health professional perspective. Methods: Thirty guideline-based interviews with German GPs and nonmedical practitioners were conducted using qualitative analysis for interpretation. Results: The health professional–patient-relationship in CAM differs from that in COM, as SDM is perceived more often. Reasons for this include external context variables (e.g. longer consultation time) and internal provider beliefs (e.g. attitude toward SDM). German health care policy was regarded as one of the most critical factors which affected the relationship between GPs and their patients and their practice of SDM. Conclusion: Differences between COM and CAM regarding the attitude toward and the perceived use of SDM are attributable to diverse concepts of medicine, practice context variables and internal provider factors. Therefore, the perceived feasibility of SDM depends on the complexity of different occupational socialization processes and thus, different value systems between COM and CAM. Practice implications: Implementation barriers such as insufficient communication skills, lacking SDM training or obedient patients should be reduced. Especially in COM, contextual variables such as political restrictions need to be eliminated to successfully implement SDM.

The purpose and aims of this qualitative descriptive study were to describe how past experiences with research (including communication, information, values and support) may contribute to research fatigue among youth and parents of youth with HIV, CF, and T1D. Eighteen parents and youth were purposively recruited from outpatient subspecialty clinics at a major academic medical center. They took part in qualitative interviews, completed a demographics form, and the Decisional Conflict Scale. Youth participants also completed the Erikson Psychosocial Stage Inventory. Two major themes emerged: blurred lines and hope for the future. Research fatigue was not found in this sample. Results point to challenges with informed consent in settings where research and clinical care are integrated, and suggest that protective factors allow for continued participation without excess burden on youth and parents. Strategies to minimize research fatigue and support engagement in research are offered.

Objective: To explore differences between conventional medicine (COM) and complementary and alternative medicine (CAM) regarding the attitude toward and the perceived use of shared decisionmaking (SDM) from the health professional perspective. Methods: Thirty guideline-based interviews with German GPs and nonmedical practitioners were conducted using qualitative analysis for interpretation. Results: The health professional–patient-relationship in CAM differs from that in COM, as SDM is perceived more often. Reasons for this include external context variables (e.g. longer consultation time) and internal provider beliefs (e.g. attitude toward SDM). German health care policy was regarded as one of the most critical factors which affected the relationship between GPs and their patients and their practice of SDM. Conclusion: Differences between COM and CAM regarding the attitude toward and the perceived use of SDM are attributable to diverse concepts of medicine, practice context variables and internal provider factors. Therefore, the perceived feasibility of SDM depends on the complexity of different occupational socialization processes and thus, different value systems between COM and CAM. Practice implications: Implementation barriers such as insufficient communication skills, lacking SDM training or obedient patients should be reduced. Especially in COM, contextual variables such as political restrictions need to be eliminated to successfully implement SDM.

Problématique: Le partenariat de soins est un concept qui s’avère prometteur pour améliorer la qualité des soins de santé offerts à la population. Les gestionnaires de proximité détiennent un rôle-clé dans son intégration en raison de leurs fonctions d’organisation des soins et de gouvernance, ainsi que de leur proximité avec les patients. But: Le but de cette étude est d’explorer l’intégration du partenariat de soins en administration des services infirmiers auprès de gestionnaires de proximité, de coordonnateurs de programme et de patients partenaires de trois unités de soins d’un centre hospitalier de la région de Montréal. D’une part, l’étude vise à explorer les perceptions des parties prenantes quant au rôle du gestionnaire de proximité dans l’intégration du partenariat de soins et, d’autre part, identifier les barrières, les facilitateurs et les compétences y étant associées. Méthodologie: Pour réaliser cette étude exploratoire descriptive, une entrevue semi-dirigée a été conduite auprès de chacun des huit participants : trois coordonnateurs de programme, deux gestionnaires de proximité et trois patients partenaires. Une analyse de contenu a été effectuée et guidée par le référentiel de compétences de pratique collaborative et partenariat patient en santé et services sociaux. Résultats: Le rôle du gestionnaire de proximité dans l’intégration du partenariat de soins en administration des services infirmiers concerne plusieurs thématiques, dont la gestion de projets, la valorisation du patient partenaire et la représentativité de la clientèle. Les principales barrières à l’intégration du partenariat de soins en administration des services infirmiers identifiées sont l’organisation des soins et la disponibilité des ressources. À l’inverse, le principal facilitateur est la gestion de projets. Les habiletés des parties prenantes peuvent être tant une barrière qu’un facilitateur. La communication, la clarification des rôles et des responsabilités et le leadership collaboratif sont des compétences-clé à maîtriser par les gestionnaires de proximité, selon les participants. Discussion/Conclusion: La variabilité dans l’intégration du partenariat de soins et l’importance de l’exercice du leadership dans la gestion des projets réalisés en partenariat sont constatées par l’étudiante-chercheure. Le rôle et le positionnement hiérarchique des coordonnateurs de programme semblent faciliter davantage l’intégration du partenariat de soins en administration des services infirmiers que ceux des gestionnaires de proximité. Un besoin de soutien en ce qui a trait à la compréhension de l’approche, au développement des compétences requises et à l’accès aux ressources en facilitant l’intégration demeure à combler. / Background: The patient partnership is a concept that appears to be promising for the improvement of the quality of care delivered to the population. The first-line managers play a key role in its integration because of their functions in care organization and governance and their proximity with the patients. Objective: The aim of this study is to explore the integration of the patient partnership in nursing administration in three units of a hospital of the greater Montreal area. On the one hand, the study will allow to explore the perceptions of the stakeholders related to the role of the first-line manager in the integration of patient partnership in nursing administration and, on the other, to identify the associated facilitators, barriers and competencies. Methods: A semi-directed interview has been conducted with each of the eight participants: three program coordinators, two unit head nurses and five patient partners. This descriptive exploratory study then included a content analysis guided by the competency framework for collaborative practice and patient partnership in health and social services. Findings: The first-line manager’s role regarding patient partnership integration in nursing administration is related to several themes including project management, valuing the patient partner and users’ representativeness. The main barriers documented regarding patient partnership integration in nursing administration are the organization of care and the availability of resources. The main facilitator relates to project management. The skills of the stakeholders are a common theme of the barriers and facilitators. According to the participants, communication, responsibilities and roles’ clarification, as well as collaborative leadership are key competencies that first-line managers need to master. Discussion/Conclusion: Variability in the integration of the patient partnership and the importance of leadership in project management regarding patient partnership were noted by the student-researcher. The role and hierarchical positioning of program coordinators seem to facilitate the integration of the patient partnership in nursing administration more than those of the first-line managers. Furthermore, support regarding understanding of the approach, competencies development and access to resources facilitating the integration is still required.

Introduktion: Vårdrelaterade infektioner (VRI), är ett hot mot folkhälsan på nationell och global nivå på grund av den belastning de anbringar drabbade patienter, anhöriga, sjukvårdssystemens samtliga delar samt späder på utvecklingen av antimikrobiell resistens genom att ofta behöva behandlas med antibiotika. VRI förebyggs genom vårdhygieniska hänsyn på vårdens samtliga beslutsfattande och utförande nivåer, samt genom att patienter och närstående möjliggörs medverkan. Patientmedverkan i att förebygga VRI är ett underanvänt och understuderat område där sjuksköterskor, i sin expertisroll inom omvårdnad i partnerskap med patienten, har möjlighet att spela en framträdande roll. Syfte: Syftet var att undersöka sjuksköterskors attityder till patientmedverkan i att förebygga VRI. Metod: Datainsamling skedde genom semistrukturerade individuella intervjuer med åtta sjuksköterskor i somatisk slutenvård. Analysmetod var kvalitativ innehållsanalys med induktiv ansats. Resultat: Elva underkategorier, tre kategorier och ett övergripande tema framkom. Kategorierna var ”Positivt med patientmedverkan”, ”Vården behöver bjuda upp” och ”Patienten behöver med på banan”. Det övergripande temat var ”Viktigt område, beroende av partnerskapet mellan vårdgivare och patient, i behov av utveckling och konkretisering”. Slutsats: Sjuksköterskors attityder till patientmedverkan i att förebygga VRI inbegriper att VRI representerar ett reellt, närvarande hälsohot som tas på största allvar. Patientens medverkan i att förebygga VRI upplevdes som ett positivt och potentiellt vinstgivande fenomen, beroende av partnerskapet mellan vårdgivare och patient. Området är i behov av att uppmärksammas, konkretiseras och utvecklas för att kunna vara en självklar del i personcentrerad och jämlik hälso- och sjukvård. / Introduction: Healthcare associated infections (HAI), are a threat to public health, both nationally and globally, due to the burden of affected patients, relatives, various parts of the healthcare system and the increasing effect it has on antimicrobial resistance, as HAI often require antibiotic treatment. HAIs are prevented by infection-prevention and control on all levels of the healthcare system including participating patients and relatives. Patient-participation in the prevention of HAI is an underused and underexplored area, where registered nurses can play a vital role as an expert in nursing care in so called partnership with the patient. Aim: The aim was to explore attitudes among nurses towards patient-participation in the prevention of HAI. Methods: Data collection was made by semistructured individual interviews with eight registered nurses, working in hospital inpatient care. The method for analysis was qualitative content analysis with an inductive approach. Results: Eleven subcategories, three categories and one all-embracing theme emerged. The categories were ”Patient-participation is positive”, ”The healthcare-system needs to invite patients” and ”Patients needs to come onboard”. The theme was ”Important topic, depending on the partnership caregiver-patient, in need of development and to be concretizised.” Conclusion: The attitudes among nurses towards patient-participation in preventing HAI includes that HAI represents a serious, real and present health-threath. Patient-participation in the prevention of HAI was perceived as a positive and potentially gainful phenomenon, depending on the caregiver-patient partnership. The topic needs to be noticed, concretized and elaborated in order to become a self-evident part of a person-centered, equal healthcare.

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This paper discusses whether current UK social policy promotes the human rights of people with dementia living in England. The author focuses on the role of recent legal reforms and key developments in social care policy--notably the Mental Capacity Act 2005 and the 2009 National Dementia Strategy--in facilitating their human rights to liberty and self-determination, particularly a right to choose to live at home. The extent to which the National Dementia Strategy provides access to services and support which provide an alternative to institutional care is critiqued. Whilst recent legislative change has endorsed the rights of people with dementia to liberty and self-determination, it is suggested there is a lack of commitment in government policy more generally to providing access to social care to enable people with dementia to exercise these human rights.

Psykiatrisk öppenvård utgör en viktig komponent inom den svenska psykiatriska vården och behovet av sådan verksamhet ökar för varje år. Specialistsjuksköterskans kompetens och patientdelaktighet utgör en framgångsfaktor för en god psykiatrisk vård, samtidigt som denna delaktighet ofta kommer med utmaningar. Utebliven delaktighet riskerar att leda till vårdlidande. Den här studiens syfte var att undersöka sjuksköterskors upplevelser av patientdelaktighet inom den svenska psykiatriska öppenvården. Upplevelsen av patientdelaktighet utforskas genom kvalitativa intervjuer med sju sjuksköterskor, som arbetar i den öppen psykiatriska vården i Västra Götalandsregionen. Studien har sin metodologiska utgångspunkt i reflekterande livsvärldsforskning och intervjuerna analyserades med hjälp av induktiv innehållsanalys. Resultatet sammanfattades till tre huvudkategorier, Främja patientens deltagande, att skapa rum för patientens röst och sjuksköterskans roll i patientens vårdresa, vilka sammanfattade intervjuernas huvudlinjer. Resultatet indikerar att patientdelaktighet i likhet med tidigare forskning är central för ökad vårdkvalitet, men också hur denna begränsas av resursbrist. Vårdrelationen framträder som en nyckelfaktor i patientdelaktigheten, men resursbrist hindrar sjuksköterskan från att bygga och bibehålla dessa. Studien bidrar med insikter gällande resurstilldelning och organisatoriska förändringar, som kan stärka patientens delaktighet, öka vårdkvalitet och minska vårdlidande. Genom att åskådliggöra sjuksköterskornas röster, belyser denna studie behovet av förändringar som möjliggör ökat patientengagemang och ökad patientdelaktighet inom psykiatrisk öppenvård. Studien belyser behovet av att adressera resursbegränsningar och implementering av individuellt anpassad delaktighet genom exempelvis tekniska hjälpmedel. Fortsatt forskning föreslås fokusera på just detta. Studien uppmanar specialistsjuksköterskor inom psykiatri att prioritera byggandet av starka, förtroendefulla relationer till sina patienter i syfte att främja patientdelaktigheten samt att använda sin expertis för att individanpassa denna. / Psychiatric outpatient care is an important component of Swedish psychiatric care, and the need for such activities increases every year. The specialist nurse's competence and patient participation are a success factor for good psychiatric care, while this participation often comes with challenges. Non-participation risks leading to poor care. The purpose of this study was to investigate nurses' experiences of patient participation in Swedish psychiatric outpatient care. The experience of patient participation is explored through qualitative interviews with seven nurses, who work in outpatient psychiatric care in the Västra Götaland region. The study has its methodological point of departure in reflective life-world research and the interviews were analyzed using inductive content analysis. The results were summarized into three main categories, promote the Patient´s Participation, to Create Space for the Patient's Voice and The Nurse's Role in the Patient's Care Journey, which summarized the main lines of the interviews. The results indicate that, similar to previous research, patient participation is central to increased quality of care, but also how this is limited by a lack of resources. The care relationship appears as a key factor in patient participation, but a lack of resources prevents the nurse from building and maintaining these. The study contributes insights regarding resource allocation and organizational changes, which can strengthen patient participation, increase care quality and reduce care suffering. By illustrating the nurses' voices, this study highlights the need for changes that enable increased patient engagement and increased patient participation in psychiatric outpatient care. The study highlights the need to address resource limitations and implementation of individually adapted participation through, for example, technical aids. It is suggested that further research focus on precisely this. The study urges specialist nurses in psychiatry to prioritize the building of strong, trusting relationships with their patients in order to promote patient participation and to use their expertise to tailor this to the individual.

The purpose of the study was to determine how professional nurses perceive their roles in patient centered care in various units, in three regional hospitals in Mpumalanga Province. The main objectives of this study were to determine * whether the working environment in provincial hospitals is supportive of patient centered care * what factors could hinder the provision of patient centered care * the extent to which patient centered care is provided to patients in provincial hospitals * professional nurses' perception of their role in patient-centered care The researcher used the descriptive exploratory method. A questionnaire with closed and open-ended questions was used to collect data from professional nurses in the three hospitals. Seventy- two (72) respondents returned the completed questionnaires. The findings indicated that the professional nurses perceived patients' and nurses' lack of knowledge as the biggest hindrance to patient centered care. Patients and relatives seemed to be less involved in their own care and the lack of information given to patients by professional nurses subsequently contributed to patients' inability to make / Health Studies / M.A. (Health Studies)