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Bakgrund: Demens är ett samlingsnamn för flera sjukdomar som drabbar hjärnan. Då människan uppnår allt högre ålder beräknas antalet personer med demenssjukdom öka, sjuksköterskor kommer att möta allt fler patienter med demens inom sjukhusvården. Symptomen skiljer sig åt mellan de olika demenssjukdomarna, nya miljöer kan förvärra symptom som förvirring och ångest. Personcentrerad vård är den vårdform som förespråkas för personer med demens och syftar till att öka en persons livskvalité. Syfte: Syftet med studien var att beskriva sjuksköterskors upplevelser av att vårda personer med demens i sjukhusmiljö. Samt att beskriva de inkluderade artiklarnas datainsamlingsmetoder. Metod: Föreliggande studie är en litteraturstudie med deskriptiv design där tolv kvalitativa artiklar analyserats. De inkluderade artiklarnas datainsamlingsmetod sammanställdes. Huvudresultat: Sjuksköterskorna upplevde att anhöriga till personer med demens var en viktig vårdresurs som skulle bejakas. Vidare upplevdes patienternas kommunikationssvårigheter försvåra sjuksköterskans symptomlindring. Slutligen upplevdes kontexten sjukhusmiljö inte vara anpassad för att ge god omvårdnad till personer med demens och tidsbrist hindrade utförandet av god vård. Sammanställningen av artiklarnas datainsamlingsmetod visade att intervjuer och fokusgrupper användes. Slutsats: Det visade sig vara komplext för sjuksköterskor att vårda personer med demens i sjukhusmiljö. Tidsbrist och en icke-demensanpassad miljö gjorde vården mer sjukdomsorienterad och tillät inte sjuksköterskan att vårda utifrån etiska värderingar och ett personcentrerat synsätt. Anhörigas resurser främjade omvårdnaden. Då sjuksköterskor upplevde svårigheter i att kommunicera med personer med demens behövs mer kompetens och utbildning i att vårda personer med demens för att öka sjuksköterskors arbetstillfredsställelse och skapa bättre förutsättningar för personer med demens som befinner sig på sjukhus. / Background: Dementia is an umbrella term for several diseases that affect the brain. The number of people with dementia is estimated to increase as human life expectancy increases, which means that nurses will meet more and more patients with dementia in hospital care. The symptoms differ between the different dementia diseases, new environments can exacerbate symptoms such as confusion and anxiety. Person-centered care is the form of care advocated for people with dementia and aims at enhancing a person's quality of life. Aim: The aim of the study was to describe nurses' experiences of caring for people with dementia in hospital environments. Also, to describe the included articles' data collection methods. Method: The present study is a literature study with descriptive design where twelve qualitative articles have been analyzed. The collected articles' data collection method was compiled. Main results: Nurses experienced that relatives of people with dementia were an important health care resource which should be welcomed. Furthermore, the patient's communication difficulties experienced complicating the times when pain should be treated. Finally, the context of the hospital environment was not adapted to provide good care to people with dementia and lack of time prevented the execution of good care. The compilation of the articles' data collection method showed that interviews and focus groups were used. Conclusion: It turned out to be complicated for nurses to care for people with dementia in a hospital environment. Lack of time and a non-suitable environment for people with dementia made the healthcare more disease-oriented and did not allow nurses to care for ethical values and a person-centered approach. Relatives' resources promoted nursing care. Since nurses experienced difficulties in communicating with people with dementia, more skills and education in caring for people with dementia are needed to increase nurses' job satisfaction and create better conditions for people with dementia in hospitals.

Background: Death can be viewed and understood through different perspectives and occurs in different ways after different trajectories. Death can occur in the hospital setting where the registered nurse has a leading role in the nursing of dying patients. It is the registered nurses’ responsibility that the given care has dignity and is respectful of the patient’s integrity. Registered nurses need an awareness of the feelings they may experience when patients die and apply different coping strategies in order to cope with the pressure that encounters with death can result in. Purpose: Was to describe registered nurses’ experiences of caring for patients who die in hospitals. Method: This literature review used scientific articles with qualitative method that were analysed in five steps according to Friberg (2017a) and was formed with an inductive approach. Result: After analysis of 12 scientific articles two main categories were presented: Emotional impact and The importance of personal and professional development with a total of five subcategories. Conclusion: Registered nurses experienced difficulties and challenges when caring for dying patients in the hospital setting and experienced emotional and professional effects as well as effects on their everyday life. Limitations within oneself and outer circumstances was perceived to limit the registered nurses from providing good care. Coping strategies could be applied in order to cope with these difficulties. / Bakgrund: Döden kan ses och förstås genom olika perspektiv och inträffar på olika sätt efter varierande förlopp. Dödsfall kan inträffa på sjukhus där sjuksköterskor har en ledande roll i omvårdnaden av patienter som avlider. Sjuksköterskor ansvarar för att given omvårdnad sker med värdighet och att patienters integritet respekteras. Sjuksköterskor behöver vara uppmärksamma på de egna känslor som kan uppkomma vid patienters dödsfall och tillämpa olika copingstrategier för att kunna hantera den belastning som möten med döden kan innebära. Syfte: Var att beskriva sjuksköterskors upplevelser av att vårda patienter som avlider på sjukhus. Metod: I litteraturöversikten användes vetenskapliga artiklar av kvalitativ metod som analyserades i fem steg enligt Friberg (2017a) och utformades med ett induktivt förhållningssätt. Resultat: Efter analys av 12 vetenskapliga artiklar presenterades två huvudkategorier: Emotionell påverkan och Betydelsen av personlig och professionell utveckling med totalt fem subkategorier. Slutsats: Sjuksköterskor upplevde svårigheter och utmaningar kring att vårda patienter som avlider på sjukhus och upplevde känslomässig, vardaglig och professionell påverkan. Inre begränsningar och yttre omständigheter upplevdes hindra sjuksköterskor från att ge god vård till patienter som avlider. Sjuksköterskor kunde tillämpa olika copingstrategier för att kunna hantera de svåra situationerna.

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In Sweden, turnover among healthcare professionals is a significant problem in hospital settings. Efficient leadership of healthcare professionals is vital for enhancing the quality and integration of healthcare. Authentic leadership (AL) is a relational leadership style instigated from the field of positive organizational conduct and is asserted to advocate healthy work environments that impact healthcare professional’s efficiency and positive organizational outcomes. This master’s thesis aims to describe the impact of AL on the work environment and patient outcomes in hospital settings. The method is a literature study. Peer-reviewed English or Swedish articles that examined the impact of AL on the work environment and patient outcomes in hospital settings were selected from seven databases. Quality appraisal, data extraction, and analysis were accomplished on the included studies. A total of 26 articles (n=24 quantitative, n=1 qualitative and n=1 mixed method) satisfied the inclusion criteria. Results were evaluated according to the literature review content analysis. Findings support positive relationships between AL and increased optimism and trust among healthcare professionals, job satisfaction and turnover, patient care quality, structural empowerment, and work engagement. Findings were, therefore, consistent with AL theory. Future studies using more diversity in research themes, settings, study populations, organizations, job areas, geographic origins, and theory context are merited. People in positions of influence in healthcare settings and healthcare practitioners can use the findings of this study as a guide to increase awareness of the processes by which AL promotes positive outcomes in the workplace.

The overall aim of the thesis was to describe patient−health-professional interactions in a hospital setting, with a specific focus on the surgical care unit. The thesis consists of four studies and includes both qualitative and quantitative studies. Content analysis and phenomenography were used in the qualitative studies; the quantitative study was an intervention study with a three-phase quasi-experimental design. The findings of study I showed that patient complaints to a local Patients’ Advisory Committee about negative interactions with health professionals most often concerned the perceived insufficiencies of information, respect, and empathy. The findings of study II showed that experiences of negative interactions with health professionals caused long-term consequences for individual patients and reduced patients’ confidence in upcoming consultations. The findings of the phenomenographic study (III) showed that surgical nurses understand an important part of their work in qualitatively different ways, which can be presented as a hierarchy of increasing complexity and comprehensiveness. In the most restricted understanding, surgical nurses focus on the work task, whereas in the others surgical nurses demonstrate increasing degrees of patient-centeredness. Finally, the results of study IV showed that an uncomplicated intervention that invited patients to express their daily questions and concerns in writing (using the ‘Tell-us card’) improved the patients’ perceptions of participation in their care in a surgical care unit. For further implementation of the Tell-us card to succeed, it needs to be prioritized and supported by leaders in ongoing quality improvement work. The value of a patient-focused interaction needs to be the subject of ongoing discussions in surgical care units. Patients’ stories of negative interactions could be used as a starting point for discussions in professional reflection sessions. It is important to discuss and become aware of different ways of understanding professional interactions and relationships with patients; these discussions could open up new areas of professional development. Providing patients an opportunity to ask their questions and express their concerns in writing, and using this information in the patient−health-professional interaction, could be an important step towards improved patient participation.

This project details the designing and implementation of an English for Specific Purposes (ESP) Curriculum to prepare English learners to become Certified Nursing Assistants (CNA) at Utah Valley Regional Medical Center (UVRMC) in Provo, Utah. UVRMC, which is owned by Intermountain Health Care (IHC), employs a group of about 40 non-native speakers of English. They work as housekeepers and have interest in learning English and consequently acquiring new skills they could use in better jobs to improve the quality of their lives. UVRMC would like these employees to obtain additional education in order to provide them with better employment opportunities. UVRMC allowed two graduate students at the Department of Linguistics and English Language at Brigham University to design and implement an ESP course to help UVRMC housekeepers improve their language skills in preparation to apply and participate in a Certified Nursing Assistant (CNA) course offered through IHC University. This report covers the linguistic needs analysis of the participants, situational analysis of UVRMC in terms of the support given to the curriculum, the designing of goals and objectives, the syllabus, the teaching of the syllabus, some material development, and the assessment of language learning. It also describes the instruments used to obtain information during each step of the designing of the curriculum and its implementation, analyzes that information, presents results, assesses the curriculum's efficacy, and explains the implications for other ESP curricula in the field of nursing and other scientific fields.

Lors de l’intégration en milieu de pratique clinique, les infirmières nouvellement diplômées peuvent vivre un choc de transition (Duchscher et Windey, 2018; Wakefield, 2018). Cette période d’adaptation à un nouveau rôle professionnel comprend plusieurs défis, et peut avoir un impact psychologique sur l’infirmière. Ces facteurs vont venir influencer l’expérience vécue de l’infirmière et la signification accordée à ce phénomène. L’intégration sera d’autant plus difficile dans un milieu complexe et particulier tel que l’hôpital sécuritaire surspécialisé en psychiatrie légale. Le but de cette recherche est d’explorer l’expérience vécue d’infirmières débutantes dans un hôpital sécuritaire surspécialisé de psychiatrie légale. Les questions de recherche à explorer sont en lien avec les aspects facilitateurs et les facteurs contraignants rencontrés durant leur parcours, le rôle de l'infirmière dans ce domaine, et leurs besoins d’accompagnement et de soutien en tant que débutantes. En effet, divers programmes de formation et d’orientation sont développés pour aider les infirmières à traverser cette période d’intégration. Cependant des difficultés persistent lors de l’intégration ce qui peut avoir un impact sur l’expérience vécue (Tingleff et Gildberg, 2014). Le cadre de référence théorique qui a permis de guider et structurer cette recherche est « De novice à expert », proposé par Patricia Benner (1982), et le stade de l’infirmière débutante est celui qui correspond aux infirmières nouvellement diplômées. Un devis qualitatif avec une approche phénoménologique interprétative (Benner, 1994) a été utilisé. Cinq infirmières (n=5) ont participé à une entrevue individuelle semi-dirigée d’une durée de trente à soixante minutes pour discuter de leur expérience vécue dans le milieu étudié qui a été enregistrée en audio. L’analyse qualitative des données a été effectuée de manière interprétative et itérative. De cette analyse ont émergé trois catégories principales, et dix sous-catégories. Les trois principales catégories sont : 1) les réalités du milieu clinique, ensuite 2) l’infirmière au cœur des soins en psychiatrie légale, et finalement 3) l’importance d’un accompagnement soutenu et personnalisé. Les résultats obtenus permettent une meilleure compréhension du phénomène étudié. Plusieurs recommandations ont été émises afin de mieux soutenir les infirmières débutantes durant leur parcours, plus spécifiquement concernant leurs besoins de formation afin d’être mieux préparées à intégrer leur rôle dans le milieu. / When integrating clinical practice settings, newly graduated nurses may experience transition shock (Duchscher & Windey, 2018; Wakefield, 2018). This period of adjustment to a new professional role includes several challenges and can have a psychological impact on the nurse. These factors will come to influence the nurse's lived experience and the meaning attributed to this phenomenon. Integration will be especially difficult in a complex and unique environment such as a secure hospital specializing in forensic psychiatry. The purpose of this research is to explore the lived experience of beginner nurses in a secure forensic psychiatric hospital. The research questions to be explored are related to the facilitating and constraining factors encountered during their journey, their role as a nurse in this subspecialty, and their needs for guidance and support as beginners. In fact, various training and orientation programs are developed to help nurses through this integration period, but despite this, difficulties persist which can impact the lived experience (Tingleff & Gildberg, 2014). The theoretical frame of reference that guided and structured this research is “From Novice to Expert” by Patricia Benner (1982), and the advanced beginner nurse stage is the stage that corresponds to newly graduated nurses. A qualitative design with an interpretative phenomenological approach (Benner, 1994) was used. Five nurses (n=5) participated in a semi-structured individual interview lasting thirty to sixty minutes to discuss their experience in the field of study that was audio recorded. The qualitative data analysis was performed in an interpretive and iterative manner. From this analysis emerged three main categories, and ten subcategories. The three main categories are: 1) the realities of the clinical setting, then 2) the nurse at the heart of forensic psychiatric care, and finally 3) the importance of sustained and personalized support. The results obtained allow a better understanding of the phenomenon studied. Several recommendations were issued to better support new nurses during their career, more specifically concerning their training needs in order to be better prepared to integrate their role in the environment.

L’utilisation des mesures de contrôle pour la gestion des comportements violents constitue une préoccupation majeure pour les infirmières qui pratiquent dans les unités de soins de santé mentale adulte. Le recours à ces mesures engendre des conséquences physiques et des traumatismes psychologiques chez les patients et tout le personnel soignant. Par conséquent, la prévention et la réduction de leur utilisation deviennent une priorité. De par l’aspect multifactoriel de cette problématique, la connaissance des facteurs qui influencent l’utilisation de ces mesures est primordiale pour cibler les interventions qui permettent de les prévenir ou les réduire. Les facteurs reliés aux caractéristiques cliniques des patients et au personnel soignant sont bien décrits dans la littérature. Toutefois, les facteurs reliés à l’environnement du patient ne sont pas attribués à l’ensemble des dimensions qui le constituent. Ceci est dû à la rareté des modèles conceptuels qui donnent une représentation structurée et globale de cet environnement. L’absence de cette représentation laisse les facteurs associés à l’environnement circonscrits seulement dans sa dimension physique, alors que d’autres facteurs reliés à ses autres dimensions sont rapportés dans la littérature sans être définis comme des facteurs environnementaux. Le but de cette revue de la portée a donc été d’explorer l’étendue des connaissances et d’identifier les facteurs de l’environnement qui sont associés à l’utilisation des mesures de contrôle chez les patients atteints de troubles mentaux. Afin d'intégrer une représentation globale de l’environnement, le cadre de référence du modèle de l’environnement thérapeutique optimal a été retenu (Optimal healing environment, ETO) (Jonas et al. , 2014). Les étapes de la revue de la portée selon Peters et al. (2020) ont été suivis, ce qui a donné lieu à l'inclusion de 35 écrits. L’analyse thématique des données extraites a permis d'identifier deux dimensions, à savoir l’environnement interpersonnel et l’environnement externe du patient. L’environnement interpersonnel décrit le développement et le maintien d’une relation thérapeutique à travers l’amélioration des compétences de communication du personnel soignant, l’utilisation des stratégies de prévention de crise d’agressivité, l’implication du patient, le retour post-évènement d’isolement et/ou contention et le sentiment d’appartenance à la communauté de l’unité de soins. Il décrit également la création d’organisations thérapeutiques via l’exercice du leadership organisationnel, les initiatives d’améliorations de l’organisation des soins, et la gestion des ressources humaines et technologiques. Pour sa part, l’environnement externe décrit la conception architecturale et le design intérieur des unités de soins où le patient est hospitalisé. Finalement, on pourrait conclure que des trois dimensions de l’ETO qui ont été incluses dans ce travail, les dimensions de l’environnement interpersonnel et l’environnement externe sont les plus représentées dans la littérature des cinq dernières années. De plus, les interventions de prévention de crise d’agressivité et le leadership organisationnel se sont montrés des facteurs clés d'un environnement thérapeutique favorisant la réduction de l’utilisation des mesures de contrôle. / The use of coercive measures (seclusion and restraints) to manage violent behaviors is a major preoccupation for adult mental health nurses. The use of these measures results in physical consequences and psychological trauma for patients and all caregivers. Therefore, prevention and reduction of their use becomes a priority. Due to the multifactorial aspect of this problem, understanding of the factors influencing this measures use is essential in order to target interventions to reduce them. Factors related to the clinical characteristics of patients and caregivers are well described in the literature. However, factors related to the patient's environment are not attributed to all of its dimensions. This is due to the scarcity of conceptual models that provide a structured, global representation of this environment. The absence of such a representation leaves the factors associated with the environment circumscribed only within its physical dimension, while other factors related to its other dimensions are reported in the literature without being defined as environmental factors. The aim of this scope review was therefore to explore the extent of knowledge and identify the environmental factors associated with reduced use of coercive measures in patients with mental disorders. In order to incorporate a holistic representation of the environment, the framework of the Optimal healing environment (ETO) model was selected (Jonas et al., 2014). The scope review steps according to Peters et al. (2020) were followed, resulting in the inclusion of 35 literatures. Thematic analysis of the extracted data identified two dimensions, namely the patient's interpersonal environment and external environment. The interpersonal environment describes the development and maintenance of a therapeutic relationship through the improvement of caregivers' communication skills, the use of aggressive crisis prevention strategies, patient involvement, the post-event return from isolation and/or restraint, and the sense of belonging to the care community. It also describes the creation of therapeutic organizations through the exercise of organizational leadership, initiatives to improve the organization of care, and the management of human and technological resources. For its part, the external environment describes the architectural and interior design of the care units where the patient is hospitalized. Finally, we may conclude that of the ETO three dimensions included in this work, interpersonal environment and external environment are the most represented in the literature of the last five years. In addition, aggression crisis prevention interventions and organizational leadership have been shown to be key factors in a therapeutic environment conducive to reducing the use of coercive measures.

Methicillin-resistant Staphylococcus aureus (MRSA) is an antibiotic-resistant bacterium of epidemiologic importance in Canadian healthcare facilities. The contact between MRSA colonized or infected patients with other patients, healthcare workers (HCWs) and/or the healthcare environment can result in MRSA transmission and healthcare-associated MRSA (HA-MRSA) infections in hospitals. These HA-MRSA infections are linked with increased length of hospital stay, economic burden, morbidity and mortality. Although infection prevention and control programs initiated in 2009 in Canada and other developed countries (e.g., UK, France, Belgium, Denmark, etc.) have been relatively successful in reducing the rate of HA-MRSA infections, they continue to pose a threat to patients, especially to the more vulnerable in long term care and geriatric institutions. Historically, MRSA was a problem mainly in hospital settings but after mid-1990s new strains of MRSA have been identified among people without healthcare-related risks and have been classified as community-associated MRSA (CA-MRSA). Furthermore, the distinction between HA-MRSA and CA-MRSA strains is gradually waning due to both the introduction of HA-MRSA in communities, and the emergence of CA-MRSA strains in hospitals. The purpose of this thesis was to explore the feasibility of constructing healthcare networks to evaluate the role of healthcare providers (e.g., physicians) and places (e.g., patient rooms) in the transmission of MRSA in a large tertiary care facility. Method of investigation: a secondary data case-control study, using individual characteristics and network structure measures, conducted at The Ottawa Hospital (TOH) between April 1st, 2013 and March 31th, 2014. Results: It was feasible to build social networks in a large tertiary care facility based on electronic medical records data. The networks' size (represented by the number of vertices and lines) increased during the outbreak period (period 1) compared to the pre-outbreak period (period 0) for both groups and at all three TOH campuses. The calculated median degree centrality showed significant increase in value for both study groups during period 1 compared to period 0 for two of the TOH campuses (Civic and General). There was no significant difference between the median degree centrality calculated for each study group at the Heart Institute when compared for the two reference periods. The median degree centrality of the MRSA case group for period 0 showed no significant difference when compared to the same measure determined for the control group for all three TOH campuses. However, the median degree centrality calculated for period 1 was significantly increased for the control group compared to the MRSA case group for two TOH campuses (Civic and General) but showed no significant difference between the two groups from the Heart Institute. In addition, there was a correlation between the two network measures (degree centrality and eigenvector centrality) calculated to determine the most influential person or place in the MRSA case group networks. However, there was no correlation between the two network’s measures calculated for physicians included in MRSA case group networks. Conclusions: It is feasible to use social network analysis as an epidemiologic analysis tool to characterize the MRSA transmission in a hospital setting. The network's visible changes between the groups and reference periods were reflected by the network measures and supported also by known hospital patient movements after the outbreak onset. Furthermore, we were able to identify potential source cases and places just prior of the outbreak start. Unfortunately, we were not able to show the role of healthcare workers in MRSA transmission in a hospital setting due to limitations in data collection and network measure chosen (eigenvector centrality). Further research is required to confirm these study findings.