Bakgrund: Höftfrakturer är en vanlig och allvarlig händelse som främst drabbar äldremänniskor. Risken för komplikationer är stor, dödligheten efter frakturen är hög och vägentillbaka till sitt vanliga liv kan för patienterna vara lång. Då livskvalitet ofta är kopplat till denegna hälsan är det viktigt att identifiera vad som påverkar livskvaliteten hos just dessa patienter. Syfte: Syftet med detta examensarbete var att studera vilka faktorer som påverkat livskvalitetenhos patienter över 60 år efter en höftfraktur.Metod: Designen i detta examensarbete var en deskriptiv, induktiv design med kvantitativ ansatssom gjordes i form av en litteraturstudie. Resultatet baserades på tretton kvantitativa studier ochstudiernas kvalitet granskades med hjälp av en kvalitetsgranskningsmall. Resultatet analyserades,likheter och skillnader identifierades. Resultat: Sex kategorier återfanns gällande vad som påverkat livskvaliteten efter höftfraktur hospatienter över 60 år: patientkaraktäristika, mental hälsa, fysisk hälsa, vården, förmåga att utföraADL samt social situation. Slutsats: Hög ålder, depression, kognitiv nedsättning, smärta, nedsatt förmåga till rörelse ochADL samt att drabbas av vårdrelaterade komplikationer var alla faktorer som visade sig påverkapatienternas självskattade livskvalitet negativt. Faktorer som visade sig positivt influeralivskvaliteten var att ha ett gott socialt stöd, erhålla god rehabiliterande träning, samt informationoch utbildning om sitt sjukdomstillstånd. Sjuksköterskan har en viktig roll i arbetet med attförbättra patienters livskvalitet då många av de påverkande faktorer som identifierats i dettaexamensarbete faller under sjuksköterskans ansvarsområde. / Background: Hip fractures are both common and serious injuries that primarily affect theelderly. There is a high risk of complications, mortality is high and the road of rehabilitation is along one. Quality of life is often intertwined with health, wherefore it is important to identify thatwhich affects quality of life for these patients. Aim: The aim of this bachelor thesis was to study which factors affect the quality of life ofpatients aged 60 and older after having suffered a hip fracture.Method: The design of this bachelor thesis was a descriptive, inductive design with aquantitative approach in the form of a literature study. The results are based on thirteenquantitative studies, which quality was assessed with the aid of a quality review template. Theresults were analyzed, similarities and differences were noted. Results: The elements that have been found to influence quality of life after a hip fracture wereorganized in six categories: patient characteristics, mental health, physical health, the health caresystem, ability to perform ADL and social situation. Conclusion: Old age, depression, cognitive impairment, pain, reduced ability to move andperform ADL independently, as well as suffering from care-related complications were elementsthat were shown to affect patients' self-rated quality of life negatively. Elements that positivelyinfluenced the quality of life were having good social support, receiving good rehabilitativetraining, as well as getting information and education about their illness. The nurse has animportant role when it comes to improving patients' quality of life, since many of the influencingelements identified in this degree project fall within the nurse's area of responsibility.

Bakgrund: Antalet barn med autism inom hälso- och sjukvård har ökat under senare decennier. Föräldrar till barn med autism söker, likt föräldrar till barn utan autism, hälso- och sjukvård, av andra skäl än autism. Dessa kan således träffa sjuksköterskor längs hela vårdkedjan. Bemötandet med barn med autism ställer extra krav på kompetens, extra tid och tålamod.  Syfte: Syftet med denna litteraturöversikt var att beskriva hur föräldrar till barn med autism erfarit bemötandet av vårdpersonal. Metod: En litteraturöversikt med deskriptiv design och kvalitativ ansats. Litteratur söktes via databaserna Cinahl och PubMed, vilket gav tio vetenskapliga originalartiklar, som analyserades enligt beskrivningen av Popenoe et al. (2021). Resultat: I resultatet framkom att föräldrar till barn med autism gällande bemötande från vårdpersonal erfarit att: vårdpersonal hade varierad kunskap om barn med autism, vårdpersonal hade svårt att kommunicera med barn med autism, vårdpersonal stöd känts otillräckligt. Slutsats: Resultatet i denna studie ger insikt i vårderfarenheter hos föräldrar till barn med autism. Beskrivelsen och förståelsen för hur föräldrar till barn med autism skulle vilja att sjukvården förbättras, skulle kunna underlätta framgångsrika bemötande för barn med autism. / Background: The number of children with autism in healthcare has increased in recent decades. Parents of children with autism, like parents of children without autism, seek health care for reasons other than autism. These can thus meet nurses along the entire care chain. Dealing with children with autism places extra demands on competence, extra time and patience. Aim: The purpose of this literature review was to describe how parents of children with autism experienced the treatment of healthcare professionals. Method: A literature review with descriptive design and qualitative approach. Literature was searched via the databases Cinahl and PubMed, yielding ten original scientific articles, which were analyzed as described by Popenoe et al. (2021). Result: The result showed that parents of children with autism regarding treatment from healthcare staff experienced that: healthcare staff had varied knowledge about children with autism, healthcare staff had difficulty communicating with children with autism, healthcare staff support felt insufficient. Conclusion: The result of this study provides insight into the caregiving experiences of parents with children with autism. Describing and understanding how parents of children with autism would like the healthcare to improve, could facilitate successful treatment for children with autism.

Introduktion: När en människa inte längre kan bli läkt från sin sjukdom går vården från botande till lindrande och benämns palliativ vård. I Sverige utgår den palliativa vården från fyra hörnstenar; kommunikation och relationer, symtomlindring, stöd till de närstående och multiprofessionellt samarbete. Såväl patientens som dennes närståendes behov behöver tillgodoses för att personcentrerad vård ska fungera, vilket ställer krav på sjuksköterskan att ha god insyn om hur det är att vara närstående till en person som vårdas palliativt.  Syfte: Studiens syfte var att beskriva upplevelser av att vara närstående till en person som vårdas palliativt.  Metod: Studien genomfördes med deskriptiv design och hade en litteraturöversikt som metod där data från tolv kvalitativa studier analyserades. Valda artiklar kvalitetsgranskades med hjälp av SBU:s granskningsmall.  Resultat: Av studiens resultat framkom tre kategorier: upplevelse av förtroende och bristande förtroende för vården, upplevelse av trygghet och otrygghet samt upplevelse av obalans i den närståendes liv. Studiens huvudsakliga fynd var att närstående upplevde ett stort ansvar för patienten samt att de upplevde ett behov av stöd vilket kunde uppfyllas i form av kunskap, anpassad vårdmiljö och goda relationer till vårdpersonalen.  Slutsats: Till framtida studier rekommenderas att undersöka hur sjuksköterskan kan underlätta för de närstående till patienter som får palliativ vård samt undersöka vilka behov som behöver tillgodoses i olika vårdmiljöer, i syfte att förbättra hälsa och förebygga ohälsa. / Introduction: When a person no longer can be cured, care moves from being curative to being palliative. In Sweden, palliative care is based on four cornerstones: communication and relationships, symptom control, support for the relatives and multi-professional teamwork. In accordance with the principles for patient-centered care, both patients and relatives' needs must be fulfilled. This put demands on nurses to understand what it is like to be family or a friend of a person who receives palliative care.  Purpose: The purpose of this study was to investigate relatives’ experiences of palliative care. Method: A literature review with a descriptive design was used. Data was collected from twelve qualitative studies. The articles’ quality was assessed with a review template.  Results: The analysis resulted in three main categories: experiences of trust and distrust, experiences of security and insecurity, and experiences of imbalance in life. The main findings signify that close relatives can perceive great responsibility for their loved ones, meaning they need support. Knowledge, a suitable care environment and good relationships with the health care staff are keys for support.  Conclusion: With the aim of improving health and preventing illness, future studies should investigate how nurses can facilitate the situation for relatives of patients receiving palliative care, and which needs need to be met in different care environments.

When students learn caring during clinical practice, the usual point of departure is thatcaring and learning coexist, as separate and parallel phenomena. There is, however, a needto study how caring and learning relate to one another, as well as when and how theyconverge. The aim of this dissertation is to describe how caring and learning converge inthe encounters between students and patients, in a dedicated educational unit withinpsychiatric care, as experienced by students, patients, and supervisors. Describing howsupervisory support can facilitate this is another aim. A reflective lifeworld approach basedon phenomenological philosophy has been applied. Data were collected through interviews,participant observations with follow-up interviews, and narrative diaries.The result shows that caring and learning converge in those encounters between studentsand patients which are characterized by reciprocity, wherein the patient’s narrative is thepoint of departure, complemented by the student’s listening and inquiring attitude. It ishere, that the desire for and pursuit of health and understanding, give the reciprocalinteraction power. The common desire of those involved to know, to become accustomedto the new and unfamiliar, as well as the presence of a feeling of responsibility for oneanother, create questions which in turn create opportunities wherein students and patientsare available to one another.The dissertation shows that learning in a caring context can be complex. Despite theirbeing prerequisites for one another, competition and conflicts can occur when the caringand learning perspectives are not equally attended to. When they are placed counter to oneanother, there is a risk that reciprocal interaction is hindered, which can cause loneliness forall involved. For convergence to occur most propitiously, those involved must exist in acaring and learning togetherness. Responsible and present supervisors are needed, whocreate possibilities for the perspectives to converge through maintenance and monitoring, sothat caring and learning receive equal space.A didactic concept has been developed based on the dissertation’s result, focusing on themeaning of creating forums where students’, patients’, and supervisors’ caringconsiderations and reflections can intertwine.

The thesis describes the phenomenon women’s health and illness experiences following a myocardial infarction (MI). The purpose of the thesis is to explore women’s experiences of their care and health processes, as well as their experiences of body, lifeworld and meaningful relationships related to the illness. A reflective lifeworld approach, based on phenomenological philosophy, is used. The thesis is comprised of four studies; three are based on interviews with a total of 26 women following an MI, followed by a fourth, theoretical, study. The first study explores women’s experiences of care and health processes following an MI, with a particular focus on well-being and participation (I). The findings show that an MI is an event that suddenly interrupts the ordinary life of the women. Participation is a sense of being involved in their own health and care processes, which may also encourage them to take responsibility for health promoting activities in a healthy and meaningful way. The second study explores women’s lifeworld experience of their bodies and lives following an MI (II). This study finds that an MI, as a major event in the women’s lives, influences and restricts their everyday activities over a long period of time. Following the illness, they live with an existential uncertainty about their life and the heart, and this feeling entails suffering for them. The third study explores the meaning of close relationships and sexuality to women’s health and well-being following an MI (III). The mmeaning of close relationships appears to be vitally intertwined with their long-term health process; both health processes and relationships are affected after an MI. The suffering following an MI can be compared to taking a fall, where meaningful close relationships can function as a safety net that catches the women in their fall. The fourth study is a concept development aimed at elucidating the meaning of the concepts uncertainty, control, secure and risk in relation to the thesis phenomenon and the findings of the empirical interview studies (IV). The existential uncertainty is an important matter in the women’s health processes. In these processes the concepts control, secure and risk play a central role. Women who have suffered an MI want to be as safe as possible in order to live well. The analysis illuminates a paradox, that the women’s ambition to achieve greater safety may lead them into an even greater experience of uncertainty. The conclusion is that women’s experiences of health and illness can be described as a journey characterized by existential uncertainty. The women’s lives go through different existential phases following an MI, which is a major event. They are not prepared for the reactions that this event causes and are in need of support and guidance to manage their illness experiences. If acknowledged and well met, the significance and meaning of the women’s reactions and experiences can give impetus and energy to their health processes.

Aim: The overall objective of the present thesis was to describe and assess the importance and impact of visits by the patients’ families in an ICU, from patient and family perspectives, and to develop, from a hermeneutic perspective, a research method to study the interplay between patient and family during the visit. Method: The comprehensive methodology of the thesis was hermeneutic. Qualitative as well as quantitative methods were applied to elucidate the issues at stake. In paper I, 198 patients were consecutively included, and data were statistically analysed to establish patient mortality and length of stay at the hospital, in relation to visits of families in the ICU. In paper II, ten patients and 24 visitors were observed during visits. In paper III, seven patients and five relatives were interviewed about their memories of the visits in the ICU. Field notes from the observations, and the interviews with patients and relatives, were interpreted and analysed inspired by Gadamer’s hermeneutic philosophy. Paper IV represents a theoretical discourse, and presents methodological aspects of the hermeneutic interpretation of data from the observations. Results: There were no significant differences between the patients having visitors and those who did not. The patient group with no visits comprised 25 %; they were older, and lived in single households, which contrasted to the patient group having visitors. Analyses of the three clinical studies revealed four themes. The themes relate to the meaning of visiting for patients and their relatives, and are as follows: the visit means to see and realize, to guard and watch, to meet, and to sacrifice. The caring entails that you witness and see with your own eyes, and that you feel a communion with the sick. From the patient perspective, the visit signifies that you are confirmed, empowering you to fight to get back to life. Communion and availability in conjunction enable an individual to achieve a thorough involvement with another being. The results of study IV disclosed that what you observe is depending on your theoretical view. If you see from your heart, you interpret from your heart. Conclusions: The conclusions drawn from the studies of the present thesis are that opportunities to create a presence in the community - a communion - between patients, relatives, and carers, are at want. The present fundamental view of caring in intensive care units is in need of change, in order to create optimal conditions for a communion. Visits need to be regarded as an essential part of caring, and relatives’ visits ought to be facilitated and encouraged. Furthermore, visits are important both for patients and their relatives, as sharing the event of critical illness, in the sense of sharing the suffering, the healing, and the restoration of health, is considered a precondition for their recovery. Care should be organized around the patients and their families. Families and patients bring their fellow stories of life, including values and beliefs, thereby increasing the probability of dignified individualized care. / <p>Akademisk avhandling som för avläggande av filosofie doktorsexamen vid Sahlgrenska akademin vid Göteborgs universitet kommer att offentligt försvaras i hörsal 2118, Institutionen för vårdvetenskap och hälsa, Arvid Wallgrens backe, Hus 2, Göteborg, fredagen den 19 oktober 2012 kl. 09.00</p>

Aim: The overall aim is to examine how a patient perspective, grounded in caring science, can be preserved and developed in the context of hospital care. Methods: The first study examines attitudes towards caring science in a clinical practice. Data were collected through focus group interviews with seven nurses, three head nurses and four senior preceptors. An interpretive approach guided the study. The results called for collaboration between clinical praxis and the academy, according to how caring science can be preserved and developed. Study II–III functioned in accordance with this goal and were conducted in collaboration with a hospital ward for people over seventyfive years of age. In an attempt to develop care the patients were invited to attend a team meeting. The data in these studies were collected using interviews and observations. Fifteen patients (study II) and nine nurses (study III) who had experienced patient participation in a team meeting participated. In these studies, a reflective lifeworld approach guided the research process. Study IV is presented as a general structure and philosophical examination in the light of Heidegger and Merleau-Ponty’s philosophies. Main Findings: To preserve and develop a patient perspective is strongly connected to existential issues, such as lived time, intersubjectivity and a meaningful existence. For the patients, vulnerability is exposed and increased when the need for hospital care arises. The team meeting is experienced as an emotional situation where existential dimensions need to be recognized. The nurses desire to develop caring is challenged by organizational and economic demands. Time presents both a possibility for an encounter as well as a threat to excellent care. Conclusions: There is a need to challenge narrow processes in modern health care that value the staffs’ work and the patients’ vulnerability in quantifiable measures of efficiency. The challenge is to take into account something that is invaluable - human existence. / <p>Akademisk avhandling som för avläggande av filosofie doktorsexamen vid Linnéuniversitetet försvaras vid offentlig disputation, 15 september 2014, klockan 10.30 i sal Myrdal, Hus K, Växjö</p>

Bakgrund: Antalet flyktingar har ökat och hälso- och sjukvårdspersonal beskriver erfarenheter av bristande förtroende, kommunikationssvårigheter och kulturers påverkan i möten med patienter. Tidigare forskning beskriver hälso- och sjukvårdspersonals erfarenheter av möten med patienter med flyktingbakgrund, dock behöver även patienternas erfarenheter belysas. Förhoppningsvis kan inhämtad kunskap från patientperspektivet underlätta vårdandet. Metod: En beskrivande systematisk litteraturstudie utifrån 12 vårdvetenskapliga artiklar har analyserats enligt Evans (2002) analysmodell. Syfte: Syftet är att beskriva erfarenheter av möten mellan patienter med flyktingbakgrund och hälso- och sjukvården i det nya landet. Resultat: Ur analysen framkom tre teman; Otillräcklig vård, Svårigheter i kommunikationen och Hälso- och sjukvårdspersonals attityder. Otillräcklig vård innefattade ett ovetande om hur hälso- och sjukvården i det nya landet fungerade och att patienternas förväntningar på vården inte alltid uppfylldes. Patienterna erfor svårigheter i kommunikationen i relation till att förstå, förklara och en rädsla över vad som kunde förmedlas. Därtill erfor patienterna att hälso- och sjukvårdspersonals attityder varierade. Slutsats: Patienterna erfor huvudsakligen bristfälliga möten med hälso- och sjukvården. Ett gott möte grundades i att hälso- och sjukvårdspersonal visade respekt, intresse och empati för patienterna.

<p>The progress of chronic disorders such as heart failure and chronic obstructive pulmonary disease affects various aspects of life. They have an deep impact on patients´experience of health and wellbeing and their functional qualities and quality of life. Several studies have in an extensive way described heart failure and chronic obstructive pulmonary disease in its own domain but few qualitative studies consider coexistence of the disorders from a caring science perspective. The aim was to describe the meaning of living with heart failure and chronic obstructive pulmonary disease from a lifeworld perspective. With a phenomenological and reflecting lifeworld approach it´s possible to describe eight patients daily experiences of living with severe and chronic disorders from their own narratives. A general structure describing the phenomenon emerges from the analysis as an acceptance of an unpredictable and changed situation in life. When bodily strengths are balanced and adjusted due to the condition of the disorders harmony will appear in life. The phenomenon´s general structure is illustrated through five constituents; <em>the failing body, make sacrifice, living the life that exist, placing one´s life in the hands of others </em>and <em>to lose one´s identity.</em></p>

The progress of chronic disorders such as heart failure and chronic obstructive pulmonary disease affects various aspects of life. They have an deep impact on patients´experience of health and wellbeing and their functional qualities and quality of life. Several studies have in an extensive way described heart failure and chronic obstructive pulmonary disease in its own domain but few qualitative studies consider coexistence of the disorders from a caring science perspective. The aim was to describe the meaning of living with heart failure and chronic obstructive pulmonary disease from a lifeworld perspective. With a phenomenological and reflecting lifeworld approach it´s possible to describe eight patients daily experiences of living with severe and chronic disorders from their own narratives. A general structure describing the phenomenon emerges from the analysis as an acceptance of an unpredictable and changed situation in life. When bodily strengths are balanced and adjusted due to the condition of the disorders harmony will appear in life. The phenomenon´s general structure is illustrated through five constituents; the failing body, make sacrifice, living the life that exist, placing one´s life in the hands of others and to lose one´s identity.