The present thesis which focuses on the needs of people with dementia and the support of their independent living in the home environment was written within the framework of the PhD study in Longevity at the Faculty of Humanities, Charles University, GAČR project co- researcher and AZV participated in during post gradual studies. Presented research focuses on the needs of home dwelling people with dementia, the needs of their informal carers, the needs and experiences with providing care of patients with dementia in acute hospital care. The text of the thesis is divided into four parts, which are based on texts reviewed and published or prepared for publication. The first three parts present own research aimed at identifying the needs of people with dementia and experiences with caring of them in their home environment and in the hospital environment during acute care. The final part presents the possibilities and services to support their independent life in their own environment.

Bakgrund: Vård i livets slut är ett område som många sjuksköterskor kommer i kontakt med. Den palliativa vården syftar till att låta patienten leva ett fullvärdigt liv fram tills att denne dör utan att förlänga lidandet. Runt en döende patient finns ofta flera närstående, närstående som kanske aldrig upplevt döden eller döendet förut. Inom palliativ vård har de närstående en viktig roll och det är vårdgivarnas uppgift att se till att närstående inkluderas och stöttas. Den moderna sjukhusvården bedrivs idag med allt större krav på ekonomisering och effektivisering vilket ökar arbetsbördan på sjukhusets avdelningar, där kurativ vård är normen. Syfte: Syftet med föreliggande studie var att beskriva närståendes erfarenheter av palliativ vård av vuxna på sjukhus. Metod: Författarna har genomfört en deskriptiv litteraturstudie där totalt 11 artiklar granskades, artiklarna hittades i databaserna Pubmed och Cinahl. En tematisk analys av artiklarnas ledde fram till studiens resultat. Huvudresultat: Resultatet visade att områden som kommunikation och information var av stor vikt och hur icke adekvat kommunikation kunde leda till lidande. Miljön där vården bedrevs ansågs viktig med önskemål om en lugn miljö som bevarade patientens integritet. Närstående efterfrågade flertalet praktiska önskemål så som övernattningsmöjligheter, mat och gratis parkering. Det var även viktig att närstående och de döende blev bemötta med respekt, empati och känslighet från sjukvårdpersonalen. Slutsats: Denna litteraturstudie visar på flertal områden där förbättringsmöjligheter finns. Genom att förbättra den palliativa vården finns möjlighet att minska lidande för både närstående och patient. Vård i livet slutskede är ett område som kräver tid, kontinuitet och goda arbetsförhållanden för personalen, något som inte alltid kan garanteras i den moderna vården. / Background: End of life care is a field that many nurses will come in contact with. The aim of palliative care is to let the patient live a life with sufficient quality until the moment of death and without prolonging suffering. In the vicinity of a dying patient there is almost always a number of relatives, relatives who might never have experienced death or the process of dying. In the palliative care process relatives have an important role and it is the responsibility of health care staff to include and support them. Modern hospitals are today subject to demands of increased economization and streamlining which increases workload on hospital wards, where curing illnesses still is the norm.  Aim: The aim of this study was to describe the experiences of relatives on the palliative care of adult patients in hospital. Method: The present study is a descriptive literature review in which a total of 11 articles have been examined. The articles were found in the databases PubMed and Cinahl. A thematic analysis of the articles led to the development of the result. Result: The result showed that topics concerning communication and information were of great importance and how inadequate communication could lead to suffering. The environment in which care was given was also considered important and it was requested that the environment should be calm and provide privacy. Relatives had multiple requests regarding practicalities such as being able to spend the night, food and free parking. It was also important that the relatives and patients were treated with respect, empathy and sensitivity from health care staff. Conclusion: This literature review showed a number of areas were there were potential for improvement. Improving end of life care is a chance to reduce suffering for both relatives and patients. End of life care is a field which requires time, continuity and good working conditions for staff, which is somethings that can’t be guaranteed in the modern hospital.

The purpose of the study was to identify factors associated with the delay in the initiation of breastfeeding to premature infants before discharge from hospital. The need for this research is evident in the current practice of feeding premature infants after a nasogastric tube is removed. The study sought to provide answers to delayed initiation of breastfeeding to premature infants before discharge from hospital. Fifty members of staff in the Sick Neonate Unit and 50 mothers of premature infants participated in the study. Self-administered data collection instruments were used to collect data from mothers of premature infants and staff of a Sick Neonate Unit in the hospital. The results showed that sociodemographic factors of staff 15 (f=30%) were 31-40 years old, and young nursing staff have decreased knowledge of breastfeeding as compared to senior and older staff members. Maternal demographic factors 36 (f=73.5%) were single and 13 (f=26.5) were married. Married mothers were more likely to breastfeed with the support of the partner than unmarried mothers. Health service factors staff views towards breastfeeding were 11(f=22.0% staff members were neutral about breastfeeding, and Eighteen (f=36.0%) staff members strongly disagreed to other methods of infant feeding. Maternal breastfeeding knowledge was one of the factors under maternal breastfeeding factors because it showed that 48 mothers (f=98.0%) did not have breastfeeding knowledge. Descriptive statistics were used to analyse data. / Health Studies / M.A. (Health Studies)

The submitted dissertation of the PhD study programme Longevity Studies was prepared and financially supported by the project GAUK - Grant Agency of Charles University No. 760219 entitled "Met and Unmet Needs Of Particularly Vulnerable Older Patients in Home and Inpatient Care", of which I am a co-investigator. The mentioned research project is also in the intentions of the strategic plan and long-term activities of the research team CELLO (Center for the Study of Longevity and Long-Term Care), which is the scientific basis of the PhD study programme Longevity Studies. The main goal of the GAUK project is to provide a comprehensive overview of the needs of vulnerable older patients who are provided health care. The project is focused on three areas, which are: the needs of patients with dementia, the needs of geriatric patients at home and the needs of geriatric patients in hospital care. Partial goals are the exploration of current knowledge of the issue based on a review of Czech and foreign literature. The aim of the survey is to find out attitudes and opinions on satisfying needs from the perspective of patients and healthcare professionals. The practical goal is to create recommendations for good practice for the health care of these patients. The dissertation consists of a total of seven...

Bakgrund: Den psykiska ohälsan ökar i Sverige. Det innebär förändringar inom den prehospitala sjukvården. Ambulanssjuksköterskans arbete riktas ofta initialt mot akuta somatiska problem, men att vårda patienter med psykosomatisk bröstsmärta till följd av ångest är också en viktig del av omvårdnadsarbetet. Detta medför stor potentiell patientnytta då obehandlad, svår ångest indirekt kan bli livshotande med hänseende till suicidrisken. För att öka kunskapen om psykosomatisk bröstsmärta finns det ett behov av att beforska området. Syfte: Att beskriva sjuksköterskors upplevelser av mötet med patienter med psykosomatisk bröstsmärta prehospitalt. Metod: Åtta sjuksköterskor varav sex vidareutbildade inom ambulanssjukvård rekryterades från tre olika ambulansstationer i Norrland. Datan insamlades genom individuella semistrukturerade intervjuer och analyserades genom en kvalitativ innehållsanalys med induktiv ansats. Resultat: Vald analysmetod resulterade i tre huvudkategorier: Samtalet har en viktig roll i mötet, Bedömningen av allvarlighetsgrad är utmanande i mötet, och Ett per- soncentrerat förhållningssätt är viktigt i mötet, med sex tillhörande underkategorier som svarar på syftet. Slutsats: Psykisk ohälsa ses vara ett fullvärdigt problem inom den prehospitala sjukvården. Sjuksköterskor inom prehospital sjukvård utesluter i första hand somatisk orsak, men ser samtalet som ett naturligt nästa steg i bemötandet och behandlingen av patienter som söker vård för psykosomatisk bröstsmärta. Samtalet i kombination med ett personcentrerat förhållningssätt anses vara de bästa verktygen i bemötandet.

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Bakgrund: Yrket sjuksköterska har bland personalen präglats av kvinnodominans och själva yrkestiteln i sig har en feminin ändelse. När män i större utsträckning väljer att utbilda sig till sjuksköterskor så uppstår nya situationer som inte förekommit tidigare när det bara funnits kvinnlig personal att förhålla sig till. Syfte: Att undersöka och beskriva manliga sjuksköterskors erfarenhet av att vårda och bemöta kvinnliga patienter i nära vårdsituationer inom den somatiska vården, samt kvinnliga patienters emotionella erfarenhet av att ha blivit vårdade av manliga sjuksköterskor. Metod: Studien bedrevs som en litteraturstudie med sökningar i databaser för omvårdnadsforskning. Både kvalitativa och kvantitativa granskningsmallar användes vid kvalitetsgranskning. En beprövad innehållsanalysmodell användes till att finna gemensamma teman ur artiklarna som till skulle bli resultatet. Resultat: Studien visade att manliga sjuksköterskor ofta är rädda för att bli anklagade för sexuella olägenheter av kvinnliga patienter. För att undvika missförstånd och tvetydigheter använde manliga sjuksköterskor sig av olika strategier som hjälp till att klara av att utföra intim vård. Intima samtal kunde enligt den manliga sjuksköterskan upplevas som lika intimt som intimberöring. Ur ett patientperspektiv framkom det att yngre kvinnliga patienter önskade att få vård av samma kön, medan äldre kvinnliga patienter inte hade samma preferenser för könet på sjuksköterskan som utförde vården. Beröring av intim karaktär var något som kunde väcka starka känslor hos den kvinnliga patienten. / Background: Nursing has traditionally been predominantly staffed by women and the work title itself has had a female connotation. When men to a larger degree enter nursing, new situations arise which didn’t before when the patients only had female staff to take into consideration. Aim: To investigate and describe the experience of nurses who are male in their care and treatment of women patients in intimate care situations in a hospital setting, as we as the emotional experience of the women clients of having been cared for by nurses who are male. Method: The study was carried out as a literature review through searches in databases containing nursing sciences. Both qualitative and quantitative review templates were used to carry out the quality review. A proven method for content analysis was used to find common themes in the articles, which eventually formed the basis for the result. Result: The study found that male nurses often were afraid of being accused of improprieties by the female patients. In order to avoid misunderstandings, male nurses used different strategies in order to be able to perform intimate care. Conversations of an intimate nature were seen as an equally sensitive matter to the male nurses. From a patient perspective it was discovered that younger female patients preferred to be cared for by nurses of the same gender, while older female patients did not specify the same preference. Intimate touch was something that could evoke strong feelings in the female patient.

Bakgrund: Psykisk ohälsa hos befolkningen har ökat och personer med psykisk och fysisk samsjuklighet har en ökad risk att dö upp till 20 år tidigare på grund av fysiska sjukdomar. Det förekommer stigmatiserande attityder mot dessa patienter inom vården och på grund av sin psykiska ohälsa blir de bemötta annorlunda och riskerar att bli utan god somatisk vård. Syfte: Att beskriva sjuksköterskors upplevelser av att vårda patienter med psykisk ohälsa inom somatisk vård. Metod: En allmän litteraturstudie med beskrivande syntes av 12 kvalitativa artiklar. Resultat: 3 teman och 7 subteman framkom. Första temat beskriver känslor som uppstod i mötet med patienter, andra temat lyfter kompetens av att vårda patienter med psykisk ohälsa och tredje temat hur vårdmiljön påverkade möjligheten till god vård för dessa patienter. Slutsats: Sjuksköterskor upplevde svårigheter att utföra god vård till patienter med psykisk ohälsa under samtliga teman. Sjuksköterskor hade en önskan att utveckla sin kompetens för att kunna hjälpa dessa patienter. Trots orsaker på arbetsplatsen som sjuksköterskor själva har svårt att ändra på, försökte sjuksköterskor anpassa sig och tillgodose de behov som patienter med psykisk ohälsa hade. / Background: Population with mental illness has increased and people with mental and physical comorbidity have an increased risk of dying up to 20 years earlier due to physical diseases. There are stigmatizing attitudes towards these patients in health care and because of their mental illness they are treated differently and risk being without good somatic care. Aim: To describe nurses' experiences of caring for patients with mental illness in somatic care. Method: General literature review with descriptive synthesis of 12 qualitative articles. Results: 3 themes and 7 subthemes emerged. First theme describes feelings that arose in the meeting with patients, second theme highlights the competence of caring for patients with mental illness and the third theme how care environment affected the possibility of good care for these patients. Conclusion: Nurses experienced difficulties in providing good care to patients with mental illness under all themes. Nurses had a desire to develop their skills to be able to help these patients. Despite causes in the workplace that nurses themselves found difficult to change, nurses tried to adapt and meet the needs of patients with mental illness.

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Thesis (M.A. (Nursing Science)) -- University of Limpopo, 2016 / The purpose of the study was to develop a protocol to enhance patient satisfaction with regard to nursing care at Health Centres and to determine factors leading to patient dissatisfaction. A quantitative, descriptive and cross-sectional research design was used for this study. The population of the study for the two Health Centres was: Agincourt Health Centre= 5697 while Thulamahashe Health Centres= 5696. Systemic random sampling method was used to select 400 respondents from each Health Centre. Data were collected through self-developed questionnaire. The questionnaire was pre-tested at Cunningmoore clinic. Reliability was ensured through conducting of a pre-test. Validity was ensured through undertaking extensive literature review. The questionnaire was also given to the supervisor for content validity. Data analysis was done through descriptive and inferential statistics using SPSS version 22 programme of data analysis. The findings indicated that factors leading to patient dissatisfaction with regard to nursing are: long waiting time, poor communication and information between nurses and patients, shortage of nurses, poor service and environmental condition and shortage of treatment (medication). The study recommends that waiting time should be reduced to less than 3 hours, shortage of nurses should be addressed, workshops and inservice training should be implemented and treatment should be monitored.