The doctoral project presents an argument for the inclusion of complementary and alternative medicine in the provision of holistic care. Over the course of history the practice of medicine has evolved with developments in science and technology and transitioned into away from its holistic origins to a more fragmented practice. The project includes relevant literature on shortcomings of conventional medicine that are in part a catalyst for the trends of increasing complementary and alternative medicine utilization. The doctoral project concludes that the benefits of complementary and alternative medicine's inclusion in care, and more specifically holistic care, is of value and further research will be of benefit to further the utilization of complementary and alternative medicine. / McAnulty College and Graduate School of Liberal Arts; / Health Care Ethics / PhD; / Dissertation;

Background Sexual health is affected by disease, dysfunction and disability but can also be experienced in spite of illness. To get a deeper knowledge of what the nurse does for the patients the background is written with the support of the holistic care and Katie Eriksson theoretical perspectives health and suffering. Aim The aim of this study is to describe the factors to why nurses do not prioritize patients' sexual health in the nursing care. Method A literature review based on nine qualitative and quantitative studies focusing on the barriers perceived by the nurses to address sexual health. Result The result of this study showed that the barriers were many. Factors related to nurses unwillingness to talk to patients about sexuality and sexual health were difficulties in nurses' psychosocial work environment and lacking competence concerning sexual health. The fact that sexuality is a sensitive subject, factors related to the patient and that it was someone else's responsibility to raise the topic were other factors that made it difficult. Conclusion We conclude that a stressed workplace where there is a lack of time and stress along with a poor education and uncertainty leads to no grasp of the subject and the problem slides between health professionals. Patients' sexual health remains untreated. If sexual health is not involved in the nursing care increases the risk for larger problems and that the patients are exposed to unnecessary suffering.

The aim of this dissertation is to contribute to the development of a strategy for church involvement in the care of vulnerable children in low income households. The extent and nature of the problems caused by HIV/AIDS is inconceivable. Of particular concern is the children affected by HIV/AIDS. There is little consensus as to whether institutionalised care can be replaced by community-based care. The church needs an informed approach for future intervention. Existing research covers the needs of children to a certain extent, but does not have conclusive answers as to how these needs should be met. There is little, if any research examining the totality of the child’s needs. This research will determine what the vulnerable child’s unmet needs are, and get a first indication of the extent to which they are being met in the low-income household. Missiology is the field within which this study is undertaken. A good understanding of mission and the link between mission and the holistic study of the needs of vulnerable children is discussed as basis for further reflection. In an attempt to determine the totality of the child’s needs, the fundamental human needs theory, developed by Manfred A. Max-Neef is used. According to Max-Neef, all human beings have 10 fundamental needs: subsistence, protection, affection, creation, idleness, understanding, participation, identity, freedom and transcendence. These needs can be satisfied by an infinite variety of satisfiers. The findings of the study include: 1. Caregivers perceive the quality of life of vulnerable children to be high, but fieldworkers’ perceive it to be poor; 2. Denial of the vulnerability of children is associated with the denial of the existence of HIV/AIDS in the community; 3. There is a lack of knowledge of the importance of early childhood, accompanied by a lack of parenting skills for optimal early childhood development; 4. Children are not provided with opportunity and skills to manage grief; 5. The protection of children against abuse and crime is questionable, and 6. The needs of the children in the safe-house do not seem to be satisfied more or less holistically than those who live in families, or vice versa. The church can play a pivotal role in addressing the needs of vulnerable children. Apart from providing care herself, the role of the church is to be a catalyst of holistic care: 1. The first task of the church is to develop a thorough and holistic understanding of the total context, such as the fundamental needs of vulnerable children and the roles of different care-givers; 2. The second task is to promote understanding of the nature of vulnerable children’s needs amongst all role-players, and 3. The third task is to facilitate the best possible use of existing resources to satisfy the prevailing fundamental needs. The most important interventions recommended are: 1. Development of skills and knowledge for early childhood development. 2. Development of knowledge and skills in age-appropriate grief management, and 3. Further study to develop integrated community-based, institutional care. / Dissertation (MA (Theology))--University of Pretoria, 2006. / Science of Religion and Missiology / MA / unrestricted

This study adopted an ethnographic approach to examine the role of the Registered Nurse (RN) in the intellectual disability sector. The research setting (The Centre) is a residential facility for clients with intellectual disability in the northern suburbs of Adelaide that opened in 1971 and was similar to a hospital with the same hierarchy of nursing. Mental deficiency nurse training was conducted there until the 1990s but that qualification is no longer recognised. The Centre is under the umbrella of a large state disability organisation that is in the process of moving clients of the service from institutions (the Centre) to community living options such as group homes. The cessation of mental deficiency nurse training and the introduction of deinstitutionalisation were considered to impact on client health and in the late 1990s a 24 hour nursing service was commenced. There was strong anecdotal evidence the service should be evaluated. A review of the literature found some research had been conducted in overseas countries with a focus on deinstitutionalisation but with a paucity of interest in the role of the RN, particularly in Australia. Ethnography, first used in anthropology as a way of describing different cultures, was chosen as the research methodology because the researcher wanted to discover how the culture influenced the role of the RN. The researcher is an RN employed in the area. As an ethnographer and participant observer, the researcher became the data collection instrument. The entire culture is considered to be the sample in ethnography and data took the form of hundreds of hours of field note entries and interview transcripts. Following analysis, the findings were presented in themes answering the research question which was in two parts. The first ‘from the perspective of the nurse, client and other health care professionals, what constitutes intellectual disability nursing?’ and secondly ‘what are the every day rituals, norms and patterns within the disability culture that shape and influence disability nursing for the Registered Nurse?’. ‘Caring for the client who is institutionalised’, ‘The RN in the disability sector having certain qualities’, ‘Working within a different paradigm’, ‘Having to assume responsibility for large numbers of unregulated workers’, ‘Having to work alongside many professional groups’ and ‘Having different educational needs’ are themes which describe the role. Themes describe the diversity of the role and in describing the registered intellectual disability nurse as ‘different’ the role is compared with that of the nurse in other settings. The current research revealed there is a need for more health related education for unregulated workers and specific intellectual disability education for registered and enrolled nurses. Themes that answer the second part of the research question are ‘hierarchical structure’, ‘the Registered Nurse's position’ and ‘role confusion’. The non-nursing management at the top of the hierarchical ladder was found to significantly limit the role of the RN who was afforded no opportunity for leadership. Confusion over the RN's role and indeed individual workers' roles was observed at all levels. Findings suggest much stronger nursing leadership is required to provide advocacy and holistic care for the client and education for the carer. An outcome of the current research was the development of a model for intellectual disability nursing (see Table 8-1).

Résumé exécutif Introduction. La prise en charge (PEC) des malades de tuberculose a été confiée à des institutions spécialisées et réduite aux seuls aspects biomédicaux du problème. En associant une revue de littérature sur les dimensions du problème posé par la tuberculose et un état des lieux sur la prise de charge de la tuberculose, les besoins non couverts par les centres de diagnostic et de traitement (CDTs) ont été identifiés dans trois districts sanitaires (DS) ruraux du Burkina Faso. Le recueil des évidences sur les interventions à même de corriger ces insuffisances (dans la littérature), associé à l’expérience des acteurs sur le terrain ont conduit à la mise en place d’un dispositif de soins. Ce dispositif intègre i) la décentralisation de la prise en charge des malades des CDTs vers les centres de santé de 1er échelon (CS), ii) l’organisation d’un soutien psychosocial au profit des malades en traitement et iii) la mise en contribution de personnes ressources pour offrir un soutien socioéconomique aux malades. Le présent travail s’intéresse à la conception et le test du dispositif au cours d’une phase pilote. La question générale de recherche était de savoir si un tel dispositif pouvait améliorer significativement non seulement les résultats biomédicaux, mais aussi le confort physique, psychologique et matériel des malades pendant leur traitement. Trois hypothèses, faisant référence aux interventions clé du dispositif de soins, ont guidé l’investigation de cette question : i) Une décentralisation du diagnostic, de l’administration des médicaments et du suivi du traitement de la tuberculose, des CDT vers les CS va contribuer à réduire pour les malades la distance à parcourir et accroitre de ce fait le taux de dépistage. ii) Un soutien psychosocial va renforcer l’estime de soi des patients tuberculeux et réduire la stigmatisation ressentie par eux. Elle contribuera à améliorer le confort psychologique des malades ainsi que les résultats de traitement. iii) Un soutien socioéconomique bien coordonné va résoudre les besoins de base des patients tuberculeux (transport, nourriture, habillement, etc.). Il va contribuer à améliorer les conditions de vie des malades ainsi que les résultats de traitement. Le contenu du présent document comprend cinq parties. La première propose une introduction, la démarche générale et le contexte où le test du dispositif a été mis en place. La seconde présente les dimensions du problème posé par la tuberculose, un état des lieux sur l’offre actuelle de soins et les interventions potentiellement efficaces pour combler les besoins non couverts. La troisième partie décrit comment le dispositif de soin a été conçu et modélisé. La quatrième partie décrit le processus d’implantation et le fonctionnement du dispositif. Enfin, la dernière partie propose une discussion générale et quelques leçons apprises. Première partie : Introduction, contexte et approche méthodologique générale. Dans un chapitre introductif, nous mettons en exergue les défis que représente la promotion de la santé, le centre d’intérêt de la thèse, l’énoncé de la question de recherche et le cheminement méthodologique. Le cheminement utilisé est emprunté au modèle proposé par Campbell et Loeb pour la mise en œuvre et l’évaluation des interventions complexes. Il comporte quatre phases : i) la phase de modélisation, ii) la phase pilote, iii) la phase d’expérimentation définitive et iv) la phase d’implantation à long terme. La conception-modélisation et le test du dispositif de soins au cours d’une phase pilote ont fait l’objet du présent travail. Le second chapitre présente le site de l’expérience. Six districts sanitaires ruraux sont répartis en un site d’intervention (3 districts couvrant un total de 8 453 km2 avec une population de 726 651 habitants en 2005) et en un site contrôle (3 autres districts couvrant un total de 9636 km2 avec une population de 719946). Les 2 sites partagent les mêmes réalités concernant l’organisation des soins en deux échelons (centres de santé de 1er échelon et hôpitaux de référence), la couverture en infrastructures (avec un rayon moyen de couverture par CS d’environ 6 kilomètres), l’organisation de la prise en charge de la tuberculose et les résultats du contrôle de cette maladie. La fréquentation des services de soins curatifs est considérée faible dans les 2 sites, comme dans les autres DS ruraux du pays. Elle se justifierait par les barrières financières, les pesanteurs socioculturelles, les perceptions négatives des populations vis à vis des services de santé et l’absence de système performant pour la prise en charge des urgences et des indigents. Dans le troisième chapitre, un cadre général d’analyse de l’implantation du dispositif et de l’évaluation de son efficacité est proposé. Des précisions sont données à propos des centres d’intérêt, du but final de l’expérience et des méthodes utilisées pour vérifier les hypothèses de recherche. Une étude du processus d’implantation sert à analyser les interactions entre les acteurs et à identifier les obstacles rencontrés de même que les insuffisances du dispositif. Une étude quasi expérimentale sert à évaluer l’efficacité du dispositif. Deuxième partie : Phase théorique. Dans le quatrième chapitre, les insuffisances de l’offre de soins par les CDTs sont décrites et une revue de littérature sur les dimensions du problème posé par la tuberculose est présentée. Les 3 interventions susceptibles de couvrir les lacunes de l’offre actuelle de soins sont alors identifiées. Troisième partie : Phase de modélisation du dispositif de soins. Dans un cinquième chapitre, le processus de modélisation du dispositif est décrit. Une simulation du fonctionnement du dispositif permet de prévoir les effets directs et indirects. Les outils de documentation et d’évaluation du dispositif sont présentés. Quatrième partie : Développement de la phase pilote. Cette partie se compose de 4 chapitres qui sont: la présentation des interventions, des résultats intermédiaires, des interactions entre ces interventions et le système de santé. L’évaluation des effets observés termine cette partie. Le sixième chapitre présente la manière dont le dispositif a été mis en place et son fonctionnement. En partant d’une démarche standardisée, obtenue après une concertation entre les différents acteurs (professionnels de santé et personnes issues du milieu de vie des malades), trois interventions ont été implantées dans les districts d’intervention. Il s’agit de la décentralisation du diagnostic et du traitement de la tuberculose dans 24 CS (8 / district), la mise en place de sessions de groupes de parole dans chaque CDT au profit des malades et la mise en place d’un comité de soutien dont les membres sont issus de l’environnement socioculturel des malades. Le septième chapitre présente les résultats intermédiaires de chaque intervention. Le huitième chapitre an alyse les interactions entre les interventions et le système de santé en place, sous forme des adaptations opérées sur le dispositif et sous forme des changements constatés dans l’organisation des soins. -Au titre des adaptations, les sessions de groupes de paroles ont été organisées dans les CDTs plutôt que dans les CS. La coordination du dispositif a été assurée par les responsables CDTs au lieu des ECDs dans deux des trois DS d’intervention. Les procédures de gestion des fonds alloués aux comités de soutien ont été allégées suites aux problèmes rencontrés. -Sur le plan managérial, le premier changement a été l’adjonction au paquet minimum d’activité (PMA) des CS, de la collecte des crachats chez les suspects et de l’administration du traitement aux malades confirmés. Les CDTs ont continué à confirmer le diagnostic (à travers l’examen microscopique systématique des crachats provenant des CS) et à contrôler la qualité du suivi des malades (à travers les supervisions dans les CS). Le second changement a été la responsabilisation des CDTs pour l’organisation des sessions de groupes de paroles avec les malades en traitement. Le troisième changement a été le soutien matériel, financier et social proposé aux malades par les comités de soutien. -Sur le plan stratégique, les pouvoirs des équipes cadres de district (ECDs) sont restés stables. Ils étaient de type bureaucratique et liés à la planification mécanique des activités, à l’allocation des ressources et à la coordination des activités. Le pouvoir d’action des malades tuberculeux s’est renforcé au cours des sessions d’accompagnement psychosocial, avec la mise en place d’associations de malades tuberculeux à Boussé et Ziniaré. Malgré les difficultés et les conflits, une dynamique de groupe s’est mise en place progressivement au niveau de chaque comité de soutien. Le neuvième chapitre présente les résultats de l’étude quasi expérimentale pour l’évaluation de l’efficacité du dispositif après 2 années de fonctionnement (2006 et 2007). On note un accroissement significatif du taux de détection des tuberculeux dans les 3 DS d’intervention, comparaison faite avec les 3 DS contrôles. Dans la cohorte des malades de 2006 et 2007, la comparaison des proportions d’échec au traitement, de malades ayant suspendu le traitement et de décès, n’a pas montré de différence significative entre les deux sites. Le dispositif a eu un impact positif sur le niveau d’estime de soi et celui du stigma ressenti, surtout des malades en traitement ayant un faible statut économique. Le dispositif semble n’avoir pas eu un effet sur la fréquentation des 24 CS d’intervention. Cinquième partie : Discussion générale et conclusion. Le dixième chapitre propose une discussion du processus d’expérimentation du dispositif de soins. Elle présente d’abord les limites et les contraintes de l’étude. Le dispositif a permis d’améliorer l’accessibilité géographique de l’offre de soins et d’enrichir son contenu, en y apportant quelques stratégies de résolution des problèmes psychosociaux rencontrés par les malades. Cependant il a eu un faible impact sur la continuité des soins quoiqu’ils aient été mieux intégrés au niveau des CS qu’au niveau des CDTs. La suite de la discussion révèle que la modélisation du dispositif est restée imparfaite, n’ayant pas pris en compte l’ensemble des facteurs pouvant potentiellement influencer les résultats attendus. Cependant, même si la prise en compte de tous ces facteurs au cours de cette phase avait été l’approche la plus probante, sa faisabilité dans le temps imparti n’était pas assurée, au regard de la complexité du dispositif qui en aurait découlé. Les conditions d’optimisation du dispositif de soins sont proposées. Elles concernent la correction des insuffisances majeures caractérisées par i) l’absence d’un circuit de l’information approprié entre les intervenants et ii) la faible intégration des composantes du dispositif conséquence directe des lacunes dans la coordination des soins. Pour optimiser ce dispositif, la coordination des soins devrait être confiée aux équipes de soins des CS. Ce chapitre se termine par la proposition d’un modèle révisé du dispositif. Le onzième et dernier chapitre, propose un retour aux hypothèses de recherche et quelques leçons à retenir. La formulation des hypothèses de recherche a facilité la mise en place des interventions, mais il a été difficile d’isoler l’effet de chaque composante du dispositif sur les résultats obtenus. Compte tenue de l’imprévisibilité et de l’incertitude qui caractérise la logique systémique, les simulations de la phase de conceptualisation-modélisation se sont révélées insuffisantes au point de rendre nécessaire la révision du modèle de départ. Cette expérience pilote peut soutenir le changement positif dans le système d’offre de soins. Elle a montré l’importance du rôle du CS de 1er échelon, pour que le dispositif soit efficace. Responding to the medical and psychosocial needs of tuberculosis patients in Burkina Faso - what strategies to adopt? Executive summary Introduction. Care for tuberculosis (TB) patients has for a long time been the responsibility of specialised institutions (sanatorium, diagnosis and treatment centre…) and reduced to only the biomedical aspects of the problem. Today the comfort and quality of life, during and after medical treatment are viewed as a legitimate concern for the tuberculosis patient. It is therefore, indispensable to adopt a method capable of improving the diagnosis and treatment of tuberculosis, taking into consideration the physical, mental and social states of the patient. A new health care system that integrates strategies capable of significantly improving, testing and treatment of tuberculosis and tackling the psychosocial problems of the patient, has been implemented in the rural context of Burkina Faso. This research work provides information on the model of care tested during a pilot phase. The research question sought to find out if such a care system could significantly, improve not only biomedical results, but also the well being of TB patients during the treatment. The investigation of the research question was guided by three hypotheses that border on the key interventions of the model of care, as follows: i) Decentralising the diagnosis, the drugs’ delivery from the diagnosis and treatment centres (DTCs), to first line health centres (FLHCs), must contribute to reducing the distance that patients cover and increase the TB detection rate. ii) Structured psychological support must improve the self confidence of patients and reduce the feeling of stigmatisation thereby, contributing to improving the well being during treatment; iii) Structured socio economic support for tuberculosis patients (transportation, food, clothing, love from neighbours, etc) must contribute to improving the well being of the TB patients and the treatment outcomes. The content of the document has been divided into five sections. The first section is the introduction, general approach and the context where the care system has been tested. The second one presents shortcomings of the TB care system in place. The third discusses the effectiveness of some interventions to improve TB care. The fourth one describes the design-modelling of the new care delivery system. The fifth one details the implementation of the care system. The fifth section looks at a general discussion of the experimental approach and some lessons learnt. Section One: Introduction, context and general approach to the trial. The weaknesses of the biomedical approach being used currently in the medical treatment strategies of TB patients are highlighted. Areas not covered by proposed DTCs in Burkina Faso are generally psychological and socio-economic. The site where the new care system was tested in the form of a quasi experimental study is presented. It is six rural health districts divided into two groups: the implementation site (3 districts covering a total of 8 453 km2 with a population of 726651 inhabitants in 2005) and a control site (3 other districts covering a total of 9636 km2 with a population of 719946 inhabitants). The number of people seeking curative care is considered very low in the two sites, just as it is in the other rural health districts in the country. This could be explained by financial barriers, socio cultural burdens, negative perceptions of the people, vis-à-vis health services and lack of efficient system for emergency treatments, and treatment for the poor. In the two sites, the organisation of health care for tuberculosis patients is based on the application of the norms and procedures enacted at the central level and on the standardisation of tasks. The same weaknesses are observed in the organisation of TB care and a low detection rate. The populations on the 2 sites base their beliefs on tuberculosis and these beliefs influence their individual and/or collective health seeking behaviours. A general methodological approach has been proposed to assess the efficacy of the new care system, at inducing positive and durable changes in health care quality and access, for TB patients. This is the model called the «continuum of accumulating evidences» proposed by Campbell and Loeb, which includes four phases: i) the modelling phase; ii) the pilot phase; iii) the final experimental phase and iv) the long-term implantation phase. The two first phase of testing the new care system are documented into the present study. Section Two: Seeking evidences of the effectiveness of the care system. Using literature reviews, the experiences aiming at tackling the problem of TB in the holistic manner have been analysed. The results of that analysis associated with the experiences of the field actor facilitated the identifying of the new care system’ key components. The theoretical care system is composed of three key components: i) decentralising the diagnosis and treatment of TB from DTCs to FLHC, geographically nearer to the people; ii) a psychosocial support to the patient during treatment and iii) socio economic support obtained with the involvement of the civil society. Section Three: Phase one: Designing and modelling of the care system. The integration of the 3 interventions is planned. It comprises a description of stakeholders, their tasks, relationships between them, and a simulation of the functions of the care system. A presentation of the expected effects on the control of the disease, on the patients and on the curative performances of HC, on the one hand, and data collection tools, on the other hand, ends this modelling phase. Section Four: Phase two: Pilot Phase. The implementation of the key interventions of the care system is described. The three interventions have been implanted in the standardised manner, in the intervention districts. It has lead to the decentralisation of the diagnosis and treatment of tuberculosis in 24 FLHC (8 districts), to the creation of parole groups in each DTC, for the benefit of TB patients, and the creation of a support committee whose members live under the same socio-cultural environments as the patients. The role of the latter is to offer socioeconomic support to TB patients. The district executive teams (DET) could not carry out the coordination of the car system as planned. Procedures for managing funds allocated to support committees were reduced, due to problems encountered. The FLHCs collected sputum samples from suspected sick people and provided TB treatment to those confirmed as being sick. The DTCs still confirmed the diagnosis (through microscopic analysis of sputum samples from FLHCs) and ensured supervision in the FLHCs. In addition, DTCs managed the parole group sessions with TB patients. TB patients benefited of material, financial and social support from the support committee. There have been an improvement in the work into DTCs and an enhanced feeling of responsibility of care providers, vis-à-vis their patients. The strength of the TB patients improved with the formation of TB patients’ clubs at Boussé and at Ziniaré. After two years of operating the care system (2006 and 2007), the results have been relatively satisfactory at the biometrical level with a significant increase in the TB detection rate in the intervention site. Comparison of rates of unsuccessful treatments, deaths and patients suspending their treatments between 2006 -2007, between the intervention and the control sites, did not show any significant difference. The care system has had a positive impact on the level of self confidence and the stigma felt, especially on TB patients with low economic status. Section Five: General Discussion and Conclusion. First of all, the limits and difficulties encountered during the experimental stage are presented. The limits are in connection with lack of precision of some measuring indicators, some techniques of data collection and the level of changes detection. The difficulties are associated with logistics produced by the health administration system in place, the relative short period of time allocated and the use of relay persons who are not the best for obtaining the sound results. The mechanism has come to improve the geographical accessibility to health care and enriched the content of health care, bringing in its wake some strategies to resolve psychosocial problems encountered by patients. However, there has been little impact on the continuity of health care in the form of organisation, even though health care integration has improved more in FLHCs, than in the district hospital. During the discussions, it came to light that designing the care system has still not been perfect, because it did not take into consideration all factors capable of influencing the expected results. Conditions for optimising the health care system are correcting the major short falls, characterised by i) lack of appropriate information channel among the actors and ii) the low level of integration of its components. To optimise this care system, health care coordination must be assigned to the health care teams in FLHCs. Meetings of the health delivery services (DTCs and FLHCs), members of the support committee and members of TB associations must be formalised. These meetings would permit the detailed analysis of the concerns of each patient and jointly contribute to finding the expected solution. This type of meeting would contribute to solving the needs of patients from all angles at the same time.

SAMMANFATTNING Begrepp som patientcentrerad vård och helhetssyn i vården verkar användas av olika yrkeskategorier, inom hälso- och sjukvård, vilket kan ur kvalitetssynpunkt kan resultera i oklarheter inom den kliniska verksamheten. Syfte: Syftet med studien var att ta reda på vilka likheter och skillnader begreppen patientcentrerad vård och helhetssyn i vården har i den vetenskapliga litteraturen. Begreppen söktes i databaserna CINAHL och PubMed. Metod: Den metod som används för att jämföra begreppen byggde på Segestens begreppsanalysmodell. Resultat: Det som främst skiljer begreppet helhetssyn i vården från patientcentrerad vård är den andliga dimensionens centrala roll. Resultatet visar även att ett patientcentrerat arbetssätt förbättrar ekonomiska resultat. Det är främst sjuksköterskor som använder sig av helhetssyn i vården. Patientcentrerad vård verkar användas främst av läkare men begreppet förekommer även bland sjuksköterskor. Det gemensamma för begreppen då det gäller karaktäristika, förutsättningar och konsekvenser, är det som definieras i kraven på god vård enligt hälso- och sjukvårdslagen. Slutsats: sjukvårdspersonalens arbetssätt och syn på patienten utifrån patientcentrerad vård och helhetssyn i vården värnar om patientens bästa. Det som skiljer begreppen kan bero på vilken yrkesgrupp som undersökts i respektive studie. Studier av begreppet patientcentrerad vård uppfattas vara mer genomförda på läkargruppen samtidigt som helhetssyn i vården tycks vara mer förekommande då det gäller sjuksköterskegruppen. Fler studier behövs för att identifiera användningen av dessa begrepp och om deras betydelse i den kliniska verksamheten. / SUMMARY Concepts such as patient-centered care and holistic care seem to be used by different professions in healthcare. Looking upon these concepts from the aspect of quality, ambiguities can arise in clinical practice. Objective: The purpose of this study was to compare the similarities and differences between the concepts of patientcentered care and holistic care as they are presented in scientific literature. The terms were searched for in the databases CINAHL and PubMed. Method: The method used to compare the concepts was based on Segesten concept analysis model. Results: what differentiates the concept of holistic care of the patient-centered care is the central role of spiritual dimension. The results also show that a patient-centered care improves economic results. The term holistic health care seems to be used primarily by nurses, while patient-centered care seems to be used primarly by physicians, even though the term does occur among nurses. Conclusion: both patient-centered care and holistic care seem to have the same goal, that of preserving the patient`s best interests. What distinguishes the concepts may depend on the profession which was examined in each study. Research studies on patient-centered care have been carried out primarily on physicians, while studies on the holistic approach in health care have focused on nurses. More studies are needed to identify the use of these concepts and their importance in clinical practice. Nyckelord: Patient-centeredness, patient-centered care, holistic care, holistic nursing.

The diploma thesis "Spiritual Care for the Elderly as a Part of a Holistic Approach" addresses the question of how the support of spirituality can help seniors to cope with the difficulties of their lives such as the transformation of social and work roles, the loss of a partner or other close people, illness and dealing with the topic of mortality and the end of life, which usually come at this age, if not even before,. We are thinking about whether spirituality only affects people of faith or religion, or is given in some form to everyone. Thesis is looking for possibilities and approaches to spiritual care also for people who have not been interested in spirituality during their lifetime, have not expressed devotion, or turned away from for some reason. The interes tis given how spiritual care is provided in various senior homes in Prague as part of a holistic view on elderly. This work demonstrates various forms of giving this care, its use and evaluation from the perspective of clients, but also employees, volunteers and clergy. Keywords age, senior, spiritual care, house for seniors, holistic approach

Bakgrund: Palliativ kommer från latinets “pallium” som betyder mantel och ska symbolisera den heltäckande vård som ska erbjudas den döende patienten och dess anhöriga. Den legitimerade sjuksköterskan som har en inriktning på palliativ vård ska ha beredskap inför det som är oväntat och oförutsägbart. Den palliativa omvårdnaden ska utföras baserad på evidens som innebär att sjuksköterskan väger samman sin expertis med tillgänglig kunskap och erfarenheter. Metod: Semistrukturerad intervjustudie med fyra deltagande sjuksköterskor som hade erfarenhet av palliativ vård. Intervjuerna spelades in och transkriberades av författarna. Syfte: Undersöka de erfarenheter som sjuksköterskor får av att arbeta i palliativ vård. Resultat: Sjuksköterskorna understryker att den palliativa vården känns på riktigt, att deras handlingar spelar stor roll för patienten och dennes anhöriga. Det blir svårt när döden kommer nära samt etiska dilemman. Det framkom att teamarbetet är viktigt inom denna typ av vård. Konklusion: Komplexa känslor tillhör vardagen för sjuksköterskor inom palliativ vård och genom sin erfarenhet samt stöttning från team kan en god omvårdnad säkerställas. En betydelsefull slutsats av denna studie är att sjuksköterskorna som arbetar i palliativ verksamhet har behov av stöd för att kunna vårda helhetsomfattande. / Background: The word palliative has its origin in the latin word “palladium” which translates to cape and works as a metaphor for the care that should embrace the patient and its whole existence. Not only do the nurse have a liability towards the patient, but also for the wellbeing of their relatives. Method: An semi-structured interview method was utilized and four nurses with experience working in palliative care participated in the study. The interviews were recorded and then transcribed by the authors. Aim: To survey nurses' experience of working in palliative care. Findings: The nurses who participated emphasized the feeling of actually making a difference in another person's life. Examples of hardship they have to endure, is when they are forced to face their own mortality and also ethical arguments. Another important part within this care is a strong team of different professions and expertise. Conclusion: Complexity is an everyday thing for a palliative care nurse. Through their professional experience and support from their colleagues, a formidable end-of-life care can be ensured. A significant conclusion of this study, is the importance of reliance for the nurses in palliative care, to ensure the patient receives comprehensive care.

Introduktion/Bakgrund: En procent av världens befolkning är drabbade av den kroniska autoimmuna inflammatoriska sjukdomen Reumatoid artrit (RA) som kan orsaka värk, trötthet, stela leder, svullnad och som bidrar till minskad livskvalitet. I dagsläget är den farmakologiska behandlingen en central del av patienternas liv vilket kan bromsa sjukdomsförloppet men inte bota den. Litteraturstudien undersöker hur alternativa behandlingsmetoder upplevs av patienter med RA. Syfte: Syftet var att belysa patienters upplevelser av alternativa behandlingsmetoder vid RA. Metod: Litteraturstudien genomfördes utifrån Polit och Becks (2021) nio steg. Litteratursökningarna gjordes i databaserna Cinahl och PubMed. Tio artiklar var relevanta för litteraturstudiens syfte och granskades med hjälp av granskningsmallar. Resultat: Resultatet baseras på tio vetenskapliga artiklar, sju kvalitativa och två kvantitativa, samt att en artikel hade mixad metod. I sammanställningen framkom två teman: Positiva upplevelser och Negativa upplevelser. Slutsats: Alternativa behandlingsmetoder bidrog till att majoriteten av patienterna upplevde minskad smärta, ångest och depression. De upplevde även att socialt stöd från andra patienter bidrog till positivt välmående samt ökat självförtroende.

Introduction:  Spiritual care encompasses seeking or expressing meaning and purpose in life. Spiritual care is significant for the palliative patient.  When the person goes through a difficult situation or suffers from an incurable disease, it is common for existential questions and spiritual needs to arise in the individual. In this situation, in order to provide spiritual care, the nurses must be established at the patient's request, and have a holistic approach. Aim: The aim of this study is to examine registered nurses’ experiences with caring for patients' spiritual health needs in palliative care in India. Method: The study had a qualitative method, and the sample consisted of a total of 7 nurses who have experience with palliative care. Data were collected through interviews and afterward transcribed and analyzed. The interviews were analyzed using a thematic analysis method where three main categories and ten subcategories emerged. Result: In the results, three main categories emerged: the Meaning of spiritual care & nurse's role, different ways to support patients with spiritual care, and the Challenges nurse face.  Conclusion: In palliative care, spiritual health is based on the patient's religious beliefs, cultural background, and personal preferences.