Background: Multiple Sclerosis (MS) is a chronic degenerative condition. It presents with highly varied physical and psychological symptoms and an unpredictable prognosis, causing difficulties for both professionals and patients. A high prevalence of comorbid psychological symptoms are reported in MS research, yet these may be underreported and underdiagnosed clinically in people with MS. Previous research has taken a dualistic approach, focussing on physical and psychological symptoms separately, resulting in a lack of knowledge on how MS is managed holistically. The aim of this research was to explore the experiences of both people with MS and professionals in the management of physical and psychological symptoms throughout the care pathway for people with MS.Methods: A qualitative approach was used. A systematic review was conducted to investigate existing qualitative literature exploring United Kingdom (UK) health care experiences of people with MS. A qualitative study using semi-structured interviews to explore the experiences of receiving or providing care for people with MS (n =24), general practitioners (n = 13), practice nurses (n = 13) and MS specialist nurses (n = 9). People with MS were purposively sampled from primary care and community settings in North West England. Primary care professionals were purposively sampled from across the North West. Specialist Nurses were purposively sampled from four NHS Foundation Trusts across the North of England. Transcripts formed the data and these were analysed using constant comparison analysis. Once themes had been derived from the data, this data was then interrogated using the concepts of candidacy and recursivity as a theoretical framework (Dixon Woods et al., 2006; Rogers, Hassell & Nicolaas, 1999).Results: Five studies meeting the review criteria were identified from the systematic review. The findings showed that previous UK research had focussed on the beginning (diagnosis) and the end (palliative care) of the care pathway for MS, resulting in a paucity of information regarding experiences of care between these points, for both people with MS and professionals. The subsequent qualitative study addressed this and identified central themes for people with MS: experiences of MS, managing self-care, access to services, interactions with health care professionals and continuity of care. For professionals the central themes identified were: the role of primary care for MS, patient-centred care for MS, access for MS care and management of people with MS. Conclusion: This study provides a unique contribution to the literature on the health care experiences of both people with MS and health care professionals responsible for their care. It has addressed the gaps in knowledge regarding the ongoing health care experiences of people with MS and the holistic management of psychological and physical symptoms. This study showed that candidacy is an appropriate theoretical framework to explain help-seeking and access to health care for MS: use of health services is based on both patient and professionals' interpretation of symptoms, perceptions of services and previous experiences. To improve identification of candidacy there is a need for greater education for patients and professionals on symptoms of MS and information on availability of local services.

<p>A severe burn is a trauma fraught with stress and pain and may change the entire course of life. This thesis focuses on care utilisation, care experiences and patient satisfaction after a severe burn.</p><p>The patients studied were treated at the Burn Unit at Uppsala University Hospital between 1980 and 2006. Burn-related health was examined using the Burn Specific Health Scale-Brief (BSHS-B), personality traits with the Swedish universities Scales of Personality (SSP), psychological symptoms using the Hospital Anxiety and Depression scale (HADS), symptoms of posttraumatic stress with the Impact of Event Scale-Revised (IES-R) and satisfaction with care using the Patient Satisfaction-Results and Quality (PS-RESKVA) questionnaire.</p><p>Those utilising care years after injury reported poorer functioning on three of the BSHS-B subscales. Personality traits had a greater impact on care utilisation than injury severity.</p><p>Social desirability was lower among care utilisers and was associated with burn-related health aspects.</p><p>The participants reported a low level of negative care experiences, the most common of which was Powerlessness.</p><p>Most patients were satisfied with care, more with quality of contact with the nursing staff, and less with treatment information. Multiple regressions showed that the BSHS-B Interpersonal relationships subscale was an independent variable related to all measured aspects of patient satisfaction. The highest adjusted R² was 0.25.</p><p>In a prospective assessment with multiple regression analyses, Age and Education, the personality traits of Stress susceptibility, Trait irritability, Detachment and Social desirability, in addition to the post-traumatic stress symptoms Intrusion and Hyperarousal, were predictors of satisfaction with care. The highest adjusted R² was 0.19.</p><p>The thesis has pointed out that interpersonal factors are related to care utilisation as well as satisfaction with care. However, satisfaction with care was only moderately associated with health and individual characteristics, which may imply that the care itself is of major importance.</p>

A severe burn is a trauma fraught with stress and pain and may change the entire course of life. This thesis focuses on care utilisation, care experiences and patient satisfaction after a severe burn. The patients studied were treated at the Burn Unit at Uppsala University Hospital between 1980 and 2006. Burn-related health was examined using the Burn Specific Health Scale-Brief (BSHS-B), personality traits with the Swedish universities Scales of Personality (SSP), psychological symptoms using the Hospital Anxiety and Depression scale (HADS), symptoms of posttraumatic stress with the Impact of Event Scale-Revised (IES-R) and satisfaction with care using the Patient Satisfaction-Results and Quality (PS-RESKVA) questionnaire. Those utilising care years after injury reported poorer functioning on three of the BSHS-B subscales. Personality traits had a greater impact on care utilisation than injury severity. Social desirability was lower among care utilisers and was associated with burn-related health aspects. The participants reported a low level of negative care experiences, the most common of which was Powerlessness. Most patients were satisfied with care, more with quality of contact with the nursing staff, and less with treatment information. Multiple regressions showed that the BSHS-B Interpersonal relationships subscale was an independent variable related to all measured aspects of patient satisfaction. The highest adjusted R2 was 0.25. In a prospective assessment with multiple regression analyses, Age and Education, the personality traits of Stress susceptibility, Trait irritability, Detachment and Social desirability, in addition to the post-traumatic stress symptoms Intrusion and Hyperarousal, were predictors of satisfaction with care. The highest adjusted R2 was 0.19. The thesis has pointed out that interpersonal factors are related to care utilisation as well as satisfaction with care. However, satisfaction with care was only moderately associated with health and individual characteristics, which may imply that the care itself is of major importance.

Background: Mental illness is growing rapidly today, with a population that is getting worse within a younger age. Parts of mental illness is linked to what we callself-harm, or self-mutilation. This in order to alleviate his/her anxiety as a result of a compulsion or impulse to add injury to one’s body, motivated by a need to master mental health or to regain emotional balance. Purpose: The purpose of this study was to illustrate how patients with self-injury behavior experience the attitudes and treatment in their received care. Method: This study is a qualitative content analysis with an inductive approach of autobiographies written by persons with self-harm. Result: Positive treatment strengthens patient self-esteem, relieves inner suffering and anxiety, and provides a foundation for a trustworthy relationship between caregivers and patients, while negative treatment, stigmatization, preconceptions and ignorance of healthcare professionals contribute to an insecure care experience for this patient group. Conclusion: Nurses working with self-injurypatients should reflect on their treatment, occupational role and responsibility towards the patient, as this group often feels poorly treated in care. Clinical significance: The content of this study addresses the problemsof caring for patients with self-harm, which may help nurses and healthcare staff to contribute to better treatment and better care. / Bakgrund: Den psykiska ohälsan kraftigt ökar i dagens samhälle, med en befolkning som mår sämre i allt yngre åldrar. En del av den psykiska ohälsan är kopplad till det vi idag kallar Självskadebeteende. Detta i syfte att lindra sin ångest som en följd av ett tvång eller en impulsatt tillfoga sin kropp skada, motiverat av ett behov att bemästra psykisk ohälsa eller av att återvinna känslomässig balans. Syfte: Syftet var att belysa hur patienter med självskadebeteende upplever bemötandet inom vården. Metod: Denna studie är en kvalitativ innehållsanalys med induktiv ansats av självbiografier skrivna av personer med självskadebeteende. Resultat: Positivt bemötande stärker patienternas självkänsla, lindrar det inre lidandet och ångesten och gav en grund för en tillitsfull relation mellan vårdgivare och patient, där istället negativt bemötande, stigmatisering, förutfattade uppfattningar och okunskap hos vårdpersonalen bidrar till en otrygg vårdupplevelse för denna patientgrupp. Slutsats: Vårdpersonal som jobbar med självskadande patienter bör reflektera över sitt bemötande, sin yrkesroll och sitt ansvar gentemot patienten, då denna grupp ofta känner sig illa bemötta inom vården. Klinisk betydelse: Denna studie lyfter problematiken runt vårdandet av patienter med självskadebeteende, vilket kan hjälpa sjuksköterskor och vårdgivande personal vid vårdmöten.

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.

The main purpose of the study was to examine the significance of contextual factors from a patient / support person perspective in order to be able to achieve quality experiences in health care for patients with an autism diagnosis. The research study was based on a member survey of the interest group Autism and Asperger's Association, whose questions mainly concerned experiences of contact with health care. From the survey, free text responses from respondents have been processed with a qualitative thematic analysis where the results show that contextual factors such as competence, attitude, accessibility and continuity according to the respondent group can contribute to quality experiences in health care. The results from the analysis also showed a correspondence between these factors and the fundament on which the thesis' theoretical starting point, the theory of person-centered care, rests. This means that tools to meet the needs of autism patients are already available for professionals within the line of health care, but that these probably need to be complied to a greater extent and adapted to a greater extent to this patient group.This research study is relevant for the line of social work because as a professional in this widespread working area you often come across individuals which has an autism spectrum disorder. This may involve work with users and patients in areas such as health care, social psychiatry or social welfare. Regardless of the profession in which professionals meet people with autism, a general knowledge of associated disabilities and the related needs that may arise is needed. / Studien hade som sitt huvudsakliga syfte att ur ett patient/stödpersonsperspektiv undersöka kontextuella faktorers betydelse för att skall kunna uppnå goda vårdupplevelser inom hälso- och sjukvård för patienter med en AST-diagnos. Studien utgick från en medlemsundersökning av intresseorganisationen Autism- ochAsperger förbundet vars frågor främst berörde upplevelser av kontakt med hälso- och sjukvård. Från undersökningen har fritextsvar från respondenter bearbetats med en kvalitativ temaanalys där resultaten visar att kontextuella faktorer som kompetens, bemötande, tillgänglighet och kontinuitet enligt respondentgruppen kan bidra till goda vårdupplevelser. Resultaten från analysen visade även en överenstämmelse mellan dessa faktorer och de fundament som uppsatsens teoretiska utgångspunkt, teorin kring personcentrerad vård vilar på. Detta innebär att verktyg för att tillgodose AST-patienters behov redan finns att tillgå för vården men att dessa troligtvis behöver efterlevas i högre grad och anpassas i högre utsträckning efter den aktuella patientgruppen. Studien är relevant för socialt arbete då man som yrkesutövare inom detta breda yrkesområde ofta kommer i kontakt med individer som diagnostiserats med AST. Det kan handla om arbete med brukare och patienter inom områden som exempelvis hälso- och sjukvård, socialpsykiatri eller biståndshandläggning. Oavsett inom vilken profession som professionella möter personer med AST behövs en generell kunskap om tillhörande funktionsnedsättningar och till dessa kopplade behov som kan uppstå.

The subject of this diploma thesis is to analyze and describe the specific experiences of three caregivers with a home hospice care using chosen qualitative research method. It try to find answers to questions about why these people chose home hospice care, in what they see its positives and negatives and what obstacles and problems need to be overcome during care. The first part focuses on the characteristics of home hospice care, the introduction of various concepts of bereaved and mapping support for caregivers. In the second part is done phenomenological investigation of experiences of these three participants of research.