ABSTRACT   Introduction: During the past 40 years the ambulance service in Sweden has evolved from mainly being a source of transport to today’s high-tech caring facilities that enable qualified care to start already in the patient’s home. This first level of care is now provided by registered nurses and registered nurses with specialist training in pre hospital care. At the same time as the care provided is becoming more advanced, results from studies demonstrate that the amount of dispatches to patients that lack the need for ambulance care and transport is increasing. Nurses in pre-hospital care possess the knowledge, training and authority to perform an initial assessment of patients and also treat patients according to local and national guidelines. After the treatment it would sometimes be possible for the patients to remain at home without having to use ambulance transport to an emergency department or in other cases find other means of transport to hospital. Today this is, in Sweden, an accepted standard for by district nurses who are mandated to refer, even after only telephone consulting, the patients to self-care. Ambulance nurses lack this according to present guidelines. If a patient is to remain on-scene or home, a strict protocol of documentation has to be filled-in as well as the ambulance crew being in contact with a doctor. In this study, the authors visualize what patient categories stay on-scene or home, what types of examinations was performed and if the patient safety is ensured.   Objective: The aim of this study was to visualize patient safety when the patient is not transported to hospital by ambulance.   Method: A quantitative, descriptive and retrospective design and analysis of 137 ambulance medical records where the patient was left at home after the initial assessment.   Results: The results demonstrate that the patients who wish to remain on-scene have various different conditions. The majority stayed home at their own request and without any further treatment being performed by the pre hospital care provider. In 28 per cent the patients received some kind of treatment, and in some of the cases patients refused ambulance transport even when the ambulance nurse strongly recommended this. This study also demonstrated that, in many cases, the patients´ history as well as the patients´ status were incomplete documented. The ambulance nurse performed, in median, four different examinations on the patients. In more than half of the cases the nurses had documented that the patient had some kind of attendance. Counseling was given both to patients and sometimes to the patients’ family member.  A lack of sufficient documentation in the patients’ medical record was found and also that consultation of a doctor only has been completed in 15 per cent. Of a total of 137 patients there were three patients who called for an ambulance within the following 24 hours. One of these became aggressive during the first time of visit, and therefore the nurse wasn´t able to examine her thoroughly.  The two other patients do not differ regarding the extent of the examination compared to those who didn´t call for ambulance again.   Conclusion:  Although this paper demonstrates that patients´ safety has not been compromised in the examined records, the authors recommend further studies on patient safety when patient remain on-scene. There is also a need for more specific and valid indicators. Documentation and adherence to guidelines were, however, in this study found to be insufficient.  Key words: patient safety, ambulance, patient, specialist nurse in pre hospital care science, nurse, transport, journal.

Bakgrund: Kvinnlig könsstympning är en gammal tradition där delar av könsorganet avlägsnas och ibland sys ihop. Det icke-medicinska ingreppet utförs på kulturella grunder och syftar till att kontrollera sexualiteten och omvandla flickan till kvinna. Trots att ingreppet bryter mot de mänskliga rättigheterna beräknas 140 miljoner kvinnor världen över vara könsstympade. Det är därför relevant för sjuksköterskor att införskaffa sig kunskap om de vårdbehov som kan finnas hos denna grupp kvinnor.  Syfte: Att beskriva kvinnors upplevelser efter att ha genomgått könsstympning.  Metod: Litteraturöversiktens material utgörs av tolv kvalitativa och två kvantitativa studier. Databaserna som användes var Cinahl Complete, PsykINFO och Medline.  Resultat: Resultatet delades in i fyra teman; att känna rädsla och smärta i nära relationer, att mötas med förståelse men också brist på kunskap, att känna sig påverkad själsligt och kroppsligt samt att känna utanförskap men behöva samhörighet.  Slutsats: Kvinnor som lever med könsstympning upplever sig ha blivit stigmatiserade och fråntagna bestämmanderätten över sin kropp i möten med vården. Kunskapsbrist hos vårdaren har lett till känslor av otrygghet och rädsla hos kvinnorna. Då majoriteten lever med fysiska och psykiska konsekvenser från ingreppet behöver vården ha kompetens för att möta dessa kvinnor. Upplevelser av smärta och ångest i sexuella och sociala möten med partnern tydliggör även att omvårdnaden måste omfatta hela familjen. En bredare syn på sex påverkade kvinnornas upplevelser av att ha en god sexuell hälsa. / Background: Female circumcision is an old tradition where parts of genitalia are removed and sometimes sewn together. The non-medical procedure is performed on cultural grounds and aims to control sexuality and to transform the girl into a woman. Despite the violation of human rights an estimated 140 million women worldwide are genitally mutilated. It is therefore relevant for nurses to gain knowledge about the health interventions needed for this group of women. Aim: To describe women’s experiences after genital mutilation. Method: The material in this literaturereview consists of twelve qualitative and two quantitative studies. The databases used were Cinahl Complete, PsykINFO and Medline. Results: Four themes occurred; to feel fear and pain in close relationships, to be met with understanding but also lack of knowledge, to feel affected mentally and physically and to feel exclusion but need belonging. Conclusion: Women living with genital mutilation feel stigmatized and deprived of the right to decide over their own bodies in encounters with healthcare. Lack of knowledge by the caregivers has led to feelings of insecurity and fear. As the majority live with physical and mental consequences from the procedure, the caregivers need competence to meet the womens needs. Experiences of pain and anxiety in sexual and social encounters with partners also makes it clear that the health interventions must adress the whole family. A broader view of sex affected the womens view on having a good sexual health.

Bakgrund: Palliativ vård ges för att lindra lidandet vid livets slutskede. Det beslutas om palliativ vård då medicin eller andra åtgärder inte längre är kurativa. Behovet av palliativ vård ser ut att öka längre fram och det finns områden som behöver utvecklas. I Socialstyrelsens kunskapsstöd för palliativ vård är en av de fyra hörnstenarna stöd till närstående. Då närståendes roll är viktig för patientens vård krävs det att även de får stöd. Syfte: Att beskriva närståendes upplevelser av palliativ vård. Metod: Detta självständiga arbete designades som en litteraturöversikt. Datainsamling skedde i två databaser, Cinahl Complete och PubMed.Tio kvalitativa artiklar inkluderades och sammanställdes i ett resultat som sedan analyserades. Resultat: Fyra kategorier identifierades: 1) Relationen mellan vårdpersonal och närstående, 2) Egenskaper som närstående uppskattade att vårdpersonalen hade, 3) Kommunikation och information samt 4) Närståendes upplevelser av vårdmiljön. Sammanfattning: I resultatet framkom tre viktiga faktorer som påverkade närståendes upplevelse av palliativ vård. 1) Sjuksköterskans bemötande, 2)Kommunikation och information samt 3) Vårdmiljön. / Background: Palliative care is provided to alleviate suffering at the end of life. Palliative care is decided when medication or other measures are no longer curative. The need for palliative care seems to increase in the future and there are areas that need to be developed. In the knowledge support for palliative care made by Socialstyrelsen, one of the four cornerstones is support for close relatives. Relatives’ role is important for the patient's care, it is important that they also receive support. Aim: To describe relatives’ experiences of palliative care. Method: This independent work was designed as a literature review. Data was collected in two databases, Cinahl Complete and PubMed. Ten qualitative articles were included and compiled into a result that was then analyzed. Results: Four categories were identified: 1) The relationship between care staff and relatives, 2) Characteristics that relatives appreciate that the carestaff has, 3) Communication and information and 4) Relatives’ experiences of the care environment. Summary: The results revealed three important factors that affected the relatives ́experience of palliative care. 1) The nurse ́s treatment, 2)Communication and information and 3) the care environment.

Introduction: In Sweden, approximately 57,000 people suffer from Healthcare associated infection (HAI) annually, of which half of the infections are estimated to be avoidable. This can lead to consequences such as extended treatment time, increased costs for the patient and increased patient mortality as well as increased care costs. Today, there is a large scientific base on prevention and the cause of HAI from a healthcare perspective. However, there is a lack of evidence regarding patients' experience of having suffered a HAI. Attention to patients' experiences contributes to increased knowledge among healthcare personnel, which can enable improved care that can be adapted to the patient's needs. Aim: The aim of the literature study was to investigate patients' experiences of being affected by a healthcare-associated infection. Method: The study has a literature study as a method with a descriptive design and a qualitative approach, which was based on eleven original scientific articles. Result: The analysis of the articles resulted in two categories with four subcategories each. The category An inner perspective of HAI described patients' experiences of HAI on a personal level, where patient experiences of being affected, isolated, limitation, impact on social relationships, new routines and behaviors were identified. The category An external perspective of HAI describes patients' experience of HAI influenced by factors from the environment where experiences in information, communication, care management, finances and the accusation have been identified. Conclusion: Many and different dimensions of experiences emerged throughout the HAI course that affected the quality of life physically, emotionally and socially. Patients' experiences could be traced to various causes that could have been addressed. The result indicated a lack of care management in the form of substandard communication, information, knowledge and hygiene routine. Also a lack of care management regarding person-related care with a lack of awareness that patients had emotional experiences and how these could be responded to. Keywords: Literature study, nursing, patient perspective, healthcare-associated infection, care science / Introduktion: I Sverige drabbas cirka 57 000 personer årligen av en vårdrelaterad infektion (VRI) varav hälften av infektionerna uppskattningsvis kan undvikas. Det kan leda till konsekvenser som förlängd vårdtid, ökade kostnader för patienten och ökad patientdödlighet samt ökade vårdkostnader. Det finns idag ett stort vetenskapligt underlag om prevention och orsak till VRI ur ett vårdperspektiv. Däremot förekommer bristande underlag om patienters upplevelse av att ha drabbats av VRI. Uppmärksamhet av patienters upplevelser och erfarenheter bidrar till ökad kunskap hos vårdpersonal, vilket kan möjliggöra förbättrat omhändertagande och förbättrande åtgärder som kan anpassas till patienternas behov. Syfte: Syftet med litteraturstudien var att undersöka patienters upplevelser av att drabbas av en vårdrelaterad infektion Metod: Studien har litteraturstudie som metod med deskriptiv design och kvalitativ ansats, som baserades på elva vetenskapliga orginalartiklar. Resultat: Analysen av artiklarna resulterade i två kategorier med fyra subkategorier vardera. Kategorin Ett inre perspektiv av VRI beskrev patienters upplevelser av VRI på det personliga planet där patientupplevelser av att drabbas, isolering, begränsning, påverkan på sociala relationer samt nya rutiner och beteenden identifierats. Kategorin Ett yttre perspektiv av VRI beskriver patienters upplevelse av VRI påverkat av faktorer från omgivningen där upplevelser inom information, kommunikation, vårdhantering, ekonomi samt ansvarsfrågan identifierats.  Slutsats: Det framkom många och olika dimensioner av upplevelser genom hela VRI- förloppet, som påverkat livskvaliteten fysiskt, emotionellt och socialt. Patienters upplevelser kunde härledas till olika orsaker som hade kunnat åtgärdas. Resultatet visade på bristande vårdhantering i form av undermålig kommunikation, information, kunskap och hygienrutin. Även bristande vårdhantering gällande personcentrerad vård med avsaknad av en medvetenhet kring att patienter hade emotionella upplevelser och hur dessa kunde bemötas. Nyckelord: Litteraturstudie, omvårdnad, patientperspektiv, vårdrelaterad infektion, vårdvetenskap