Bakgrund: Utifrån ett sjuksköterskeperspektiv är kommunikation, och därigenom skapande av förståelse och mening, en grundläggande del av omvårdnadsarbetet. Att som sjuksköterska utveckla en positiv sjuksköterska-patientrelation är av fundamental vikt för säkerställandet av god omvårdnad. Effektiv kommunikation leder till högre patienttillfredsställelse, högre patientdelaktighet och förbättrade hälsoresultat.  Kommunikationen mellan sjuksköterska och patient kan påverkas negativt av kommunikationsbarriärer. Sjuksköterskans roll är att minimera de negativa konsekvenserna av existerande kommunikationsbarriärer genom att använda de metoder som ger bäst förutsättningar för god kommunikation i den givna situationen. Det finns ett behov att identifiera vilka barriärer för kommunikation som sjuksköterskor upplever samt hur sjuksköterskor kan övervinna dessa problem.  Syfte: Syftet var att undersöka hur sjuksköterskan upplever kommunikationen mellan patient och sjuksköterska då det föreligger kommunikationsbarriärer samt vilka åtgärder för att överbrygga kommunikationsbarriärer sjuksköterskan har erfarenhet av. Metod: Litteraturstudie med deskriptiv design. Litteratursökningen innefattade databaserna Pubmed, Psycinfo och CINAHL. Resultatet baserades på tio originalartiklar med kvalitativ ansats som var publicerade mellan 2012 till 2019.  Resultat: Under resultatanalysen identifierades två teman: Kommunikationsbarriärer samt Åtgärder och/eller metoder att överbrygga kommunikationsbarriärer. Inom varje tema identifierades kategorier och/eller underkategorier. Tolv kategorier av kommunikationsbarriärer har identifierats och sjuksköterskans upplevelse av dessa har beskrivits. Fem olika strategier och metoder som etableras av sjuksköterskorna har identifierats, att spendera tid på kommunikation, att använda tolk, att kommunicera via närstående, kunskap och utveckling samt kommunikativa strategier.  Slutsats: Studien förser sjuksköterskan med kunskap om kommunikationsbarriärer och redskap för att motverka ineffektiv kommunikation. Samtidigt rekommenderas vidare forskning för att stärka klinisk omvårdnad. / Background: From a nursing perspective communication is an integral part of nursing. Nurses need to establish a positive nurse-patient relationship to ensure good nursing practice. Effective communication leads to higher patient satisfaction, higher patient participation and a better health outcome.  The communication between nurse and patient can be negatively impacted by communications barriers. The nurse’s role is to minimize the negative consequences of existing communication barriers by using methods best adapted for the specific situation. There is a need to identify the barriers for effective communication that nurses experience and methods to overcome these communication barriers.  Aim: The aim of this study was to investigate how nurses experience the communication between patients and nurses while communication barriers exist as well as to investigate how nurses experience efforts to overcome communication barriers.  Method: Literature review with a descriptive design. The literature search encompassed three databases: Pubmed, Psycinfo and CINAHL. The results were based on ten original articles using a qualitative approach, published between 2012 and 2019.  Results: During the data analysis two themes were identified: Communication barriers and Measures and methods to overcome communication barriers. These two subject categories were subsequently divided into categories and/or sub-categories. This study has identified twelve communication barriers faced by nurses in their daily work and the nurse’s perceptions in this context. Five different categories relating to strategies and methods to overcome communication barriers, as perceived by the nurses, were identified.  Conclusion: This study provides knowledge and tools for nurses to counteract ineffective communication. Further research is recommended to further strengthen clinical practice.

Communication is central to palliative care. It unifies all nursing practice, and plays an integral role in the operationalization of palliative care. To deliver quality palliative care, it is paramount that nurses have adequate communication skills. Positive patient outcomes are derived when communication between the nurse and patient is effective. Ineffective communication may result in inaccurate information on treatment/medication increase patient risks and may cause patient dissatisfaction with care. It is therefore necessary to be familiar with the facilitators and barriers that influence communication. This study aimed to describe barriers and facilitators of effective communication between nurses and patients receiving palliative care. A literature review of fifteen articles was utilized to answer the study’s aim. Searching the CINAHL Complete and MEDLINE databases performed data collection. Data was analyzed using the matrix method. The findings were categorized into two main themes: barriers of effective communication and facilitators of effective communication. Three subthemes emerged under the barriers of effective communication and two sub themes for the facilitators. The main barrier to effective communication was the nurse’s lack of knowledge and skills. In conclusion, the nurse-patient interaction is compounded by variables such as: nurses’ competence, patient’s attributes and environmental or care setting. All together these factors require the nurse’s ability to overcome the communication barriers and highlight the facilitators. It would be of benefit if nurses receive training in communication skills in palliative care with emphasis on transitions and how to handle them within the palliative care scope.

Background: Every day Lesbian, Gay, Bisexual and Transsexual (LGBT-persons [LGBT]) meet difficulties in life. Within healthcare they face discrimination and difficulties. The development of LGBT in society is on the rise, but still persons who don't fit the sexuality norm struggles to be accepted. Aim: The aim was to discover if nurses values effect on the meeting with persons who don't fit the sexuality norm. Method: This paper is a literature review which is based on nine quantitative articles. All the articles were analyzed by the authors looking for similarities and differences. Results: The result of the literature review was that the nurse's values do effect on their attitudes toward LGBT-persons. The result showed that nurses who had previous experience in LGBT-persons was more accepting in their meeting. It also shows that the nurse's ethnicity and religious values had effect on their attitude toward LGBT-persons. Overall majority weighs toward difficulties in the meeting with persons who don't fit the sexuality norm. Subcategories became accepting in the meeting, difficulties in the meeting, ethnicities and accepting and previous experience with LGBT-persons. Conclusion: Nurses today is more accepting in the meeting with LGBT-persons than they were 10 years ago. Still persons who don't fit the sexuality norm is feeling discriminated because of their sexuality. Nurses need more knowledge about how they can make LGBT-persons feel more accepted in their meeting. More research about LGBT-persons in healthcare is needed.

Critically ill patients experience overwhelming communication problems; caused by intubation and cognitive, sensory or language deficits that distance the patients from communicating their needs and wants from nurses and loved ones. The purpose of this study was to explore communication patterns and strategies with the aim of implementing intervention strategies for nurse/patient communication in the intensive care units. The American Association of Critical Care Nurses’ Synergy Model for Patient Care was used to guide the study. A mixed method approach using quasi-experimental design combining quantitative and qualitative data collections and analysis was used. Concurrent data collection for quantitative and qualitative data was used. Auditing of patient’s files, protocols, family counselling conference and in-service books and a survey for nurses was used for quantitative data. Qualitative data collection was through interviewing nurses and nurse managers. Lack of documentation and use of other communication strategies were the key findings of the study. In accordance with the model used for the study clinical judgment and moral distress were found to be common among nurses. Lack of collaboration between nurses and other health care workers was also attributed to poor communication with mechanically ventilated patients. Conclusions derived from the study are that nurses need to be supported through informal and formal training on documentation and use of communication methods available / Health Studies / D. Litt. et Phil. (Health Studies)

Critically ill patients experience overwhelming communication problems; caused by intubation and cognitive, sensory or language deficits that distance the patients from communicating their needs and wants from nurses and loved ones. The purpose of this study was to explore communication patterns and strategies with the aim of implementing intervention strategies for nurse/patient communication in the intensive care units. The American Association of Critical Care Nurses’ Synergy Model for Patient Care was used to guide the study. A mixed method approach using quasi-experimental design combining quantitative and qualitative data collections and analysis was used. Concurrent data collection for quantitative and qualitative data was used. Auditing of patient’s files, protocols, family counselling conference and in-service books and a survey for nurses was used for quantitative data. Qualitative data collection was through interviewing nurses and nurse managers. Lack of documentation and use of other communication strategies were the key findings of the study. In accordance with the model used for the study clinical judgment and moral distress were found to be common among nurses. Lack of collaboration between nurses and other health care workers was also attributed to poor communication with mechanically ventilated patients. Conclusions derived from the study are that nurses need to be supported through informal and formal training on documentation and use of communication methods available / Health Studies / D. Litt. et Phil. (Health Studies)

En vårdrelations uppbyggnad är en komplex process där hinder och möjligheter finns. Vårdrelationen är central i den personcentrerade vården och kan vara både vårdande och icke-vårdande. Syftet med litteraturstudien var att beskriva vårdrelationens hinder och möjligheter ur patienters perspektiv. Litteraturstudiens resultat baseras på tio vetenskapliga artiklar som har bearbetats med ett deduktivt förhållningssätt utifrån Halldórsdóttirs omvårdnadsteori. Hinder som framkom i resultatet var att vårdare ofta var för upptagna för sina patienter eller visade ovilja till sitt arbete. Det gjorde att patienterna drog sig tillbaka och kände sig ensamma. Resultatet visade att patienterna beskriver respekt och bekräftelse som två möjligheter i uppbyggnaden av en vårdrelation. Detta resulterade i att patienterna kunde tala fritt om sina behov för vårdarna. Både hinder och möjligheter kan överensstämma med Halldórsdóttirs omvårdnadsteori, där väggen står för hinder och bron står för möjligheter. Genom denna litteraturstudie framkom att det finns begränsad forskning kring ämnet därför skulle det vara av intresse att forskningen i framtiden fortsätter undersöka vårdrelationen ur patienters perspektiv. / A nurse-patient relations contexture is a complex process in which there are both barriers and facilitators. The nurse-patient relations is central to the person centered care and can be both caring and uncaring. The aim of this study was to describe the nurse-patient relations barriers and facilitators from the patients' perspective. The literature study results are based on ten scientific articles and are analyzed with a deductive approach by Halldórsdóttirs nursing theory. Barriers that emerged in the result is that nurses were often too busy for their patients or showed reluctance to work. This meant that patients withdrew and felt lonely. The result showed that patients described respect and comfirmation as two facilitators in the contexture of a nurse-patient relations. This resulted in that patients were able to speak freely about their needs for caregivers. Both barriers and facilitators could apply with Halldórsdóttirs nursing theory where the wall represent barriers and the bridge represent facilitators. Through this study it revealed that there is limited research on the topic so it would be of interest that research will continue examining the nurse-patient relations from the patients' perspective.

Background: It is valuable that the patients experience a good encounter with the nurse at the emergency department. There are several factors that can influence the encounter and the patients' perception of the nurses and the surroundings at the emergency department. To not be seen as the person you are or not treated well, is a common reason why patients feel health suffering. It is the patients' experience of the circumstances which determines whether situations cause health suffering or not. Aim: The aim of this study was to describe patients' experiences of the encounter with the nurse at the emergency department. Method: The method used in this study was a literature review, based on qualitative studies. Ten articles were analyzed according to Friberg's (2012) qualitative content analyze in five steps. Results: The researchers found five themes that specifically stood out when studies were researched. The themes were feelings of: participation, being seen, abandonment, being dependent and vulnerability. Conclusion: The experience of the encounter with the nurse at the emergency department differ from each patient. All patients want to meet a nurse who characterises kindness and warmth. The nurses are the ones who can control the outcome of the encounter at the emergency department.

The aims of this thesis are to investigate the factors influencing treatment fidelity of health behaviour change (HBC) interventions. The thesis will focus on HBC interventions delivered by practice nurses (PNs) and health care assistants (HCAs) to patients within general practice, although the findings will be explored within the context of the wider treatment fidelity literature. The thesis comprises five studies, focussed on exploring, enhancing and assessing fidelity of delivery and receipt of HBC interventions. Through developing an enhanced understanding of these areas of treatment fidelity, the thesis will also make recommendations for strategies to enhance and assess fidelity of delivery and receipt of future HBC interventions. Study one is a meta-synthesis of qualitative studies that explored the views and experiences of nurses who had delivered HBC interventions with a focus on how this can inform future delivery of HBC interventions. Study two is an Interpretative Phenomenological Analysis of PNs’/HCAs’ experiences of helping patients to change their health behaviours within the context of their routine care, and before and after delivery of an intervention to facilitate increased walking. Study three reports a quantitative assessment of delivery of intervention techniques to facilitate increased walking, as specified in an intervention protocol, by PNs/HCAs. Study four explores PNs’/HCAs’ views and experiences of the factors that influenced their delivery of the walking intervention. Study five investigates treatment receipt, by exploring patients’ understanding of, and experiences of receiving the walking intervention. The key findings from this research are that delivery and receipt of HBC interventions within general practice are influenced by a range of factors that include the providers’ confidence and skills, the patients’ expectations and/or engagement with the intervention and the general practice within which the intervention is delivered. A number of these factors are difficult to influence and so research teams need to develop a range of strategies to enhance delivery and receipt of HBC interventions. These may include appropriate preparation for providers to deliver the intervention, the provision of a simple intervention resource to support delivery of the intervention and the development of strategies to enhance patients’ understanding of intervention techniques.

Bakgrund: I Sverige är det vanligaste större gynekologiska ingreppet hysterektomi, som innebär att livmodern avlägsnas. Denna operation kan vara påfrestande för kvinnan på grund av att livmodern ofta har stor betydelse som symbol för kvinnlighet och fertilitet, vilket gör att operationen kan medföra psykiska påföljder så som depression. En av sjuksköterskans uppgifter vid operationen är att göra patienten delaktig i sin vård. Delaktighet kräver en god vårdrelation där patienten får adekvat information. Syfte: Syftet med litteraturöversikten var att beskriva patienters behov av information från vårdpersonal i samband med hysterektomi. Metod: En litteraturöversikt baserad på 11 vetenskapliga artiklar som svarade på syftet. Artiklarna inhämtades från databaserna Cinahl Complete och PubMed. Båda författarna läste och granskade artiklarna för att sammanställa de meningsbärande enheterna. I de meningsbärande enheterna fann författarna likheter och skillnader. Materialet sorterades och presenteras under huvudteman med tillhörande underteman. Resultat: Resultatet presenteras i tre huvudteman, varav två av dem har underteman. Huvudtemana består av; Behov av att få veta, Individanpassad information och Konsekvenser av bristande information. Kvinnor upplevde att de hade ett behov av att få veta vad som väntade dem och när detta inte uppfylldes ledde det till bland annat oro och rädsla. Konsekvenserna av bristande information från vårdpersonalen var även att kvinnors delaktighet i vården påverkades och att information söktes på annat håll. Diskussion: Hildegard Peplaus omvårdnadsteori användes vid resultatdiskussionen, då denna kan vara ett stöd för sjuksköterskan vid undervisande och informativa möten. Det diskuteras kring att utvecklingen av vårdrelationen har stor betydelse för hur information ges och på vilket sätt det uppfattas. Vidare diskuteras på vilket sätt vårdrelationen och delaktighet kan integreras i vården för att sjuksköterskan ska kunna ge en god omvårdnad. / Background: In Sweden the most common gynecological surgery is hysterectomy which is a procedure where the uterus is removed. This kind of surgery might be difficult for the patient because the uterus has great significance as a symbol of femininity and fertility. This means that the operation can lead to reactions such as mental depression. One of the nurses functions at surgery is to participate the patient in their care. Participation of the patient requires a good nurse-patient relationship in which the patient receives adequate information. Aim: The aim of this literature review was to describe patient’s needs for information from health professionals during hysterectomy. Method: A literature review that was based on 11 original papers which also responded to the purpose. The used databases were Cinahl Complete and PubMed. Both authors read and reviewed the articles to compile their meaningful units. In the meaningful units the authors found similarities and differences. The material was then sorted and presented under main themes with matching subthemes. Results: The results are presented in three main themes, where two of them has subthemes. The mainthemes are; The need to know, Individualized information and The consequenses of insufficient information. Women experienced that they had a need to know what was going to happen, and when this was not fullfilled it caused feelings such as anxeity and fear. The consequenses of insufficient information from health professionalswas that women's participation in their care was affected and they ended up seeking information elsewhere. Discussion: The discussion is based on Hildegard Peplau's nursing theory, which can be used as a support for the nurse in educational and informative meetings. It is discussed that the development of the nurse-patient relationship has great significance for how information is being presented and how it is being perceived. Further discussed is in what way the nurse-patient relationship and participation can be integrated within the care in order to provide a good care.

Bakgrund: Akutmottagningar är överrepresenterade när det gäller förekomsten av våld inom vården. Våldet påverkar sjuksköterskans förmåga att ge god vård negativt och riskerar både patientsäkerheten och arbetsmiljön på akutmottagningen. Syfte: Att undersöka vilka riskfaktorer som kan öka risken för att en patient uppvisar ett våldsamt beteende på akutmottagningen samt hur personalen bemöter dessa patienter. Metod: Arbetet är designat som en integrativ litteraturstudie där 12 artiklar inkluderades. Resultat: Ett flertal faktorer identifierades som betydelsefulla för risken att en patient uppvisar ett våldsamt beteende på akutmottagningen. Utifrån dem identifierades fyra faktorer som särskilt viktiga; väntetider under “strukturella faktorer”, alkohol eller drogpåverkade patienter under “substansrelaterade faktorer” samt patienter med psykiatrisk sjukdom under “medicinska faktorer”. Deltagarna i de olika studierna identifierade ofta samma faktorer, även om de lade olika mycket tyngd vid olika faktorer. Hur akutvårdspersonalen hanterade kontakten med de patienter som uppvisade ett våldsamt beteende var olika bland annat beroende på erfarenhet. Bättre kommunikation, information och ett empatiskt bemötande kunde minska risken för våldsamt beteende och avvärja ett våldsamt beteende. Slutsats: Förekomsten av våld på akutmottagningen kan sällan förklaras av en enskild faktor, utan oftast spelar många separata faktorer in. De riskfaktorerna som identifierats som enskilt största för risken för våld på akutmottagning är väntetider, alkohol och/eller drogpåverkade patienter samt patienter med psykiatrisk sjukdom. God kommunikation, information och empati kan minska risk för våld eller kan minska eller förebygga att våld uppstår. / Background: Emergency departments are over-represented in the incidence of violence in health care. Violence affects nurses' ability to provide good care in a negative way and increases the risks to both patient safety and workplace environment. Purpose: To investigate the risk factors that can increase the risk of a patient exhibiting violent behavior in the emergency department and how the staff treats these patients. Method: The thesis is designed as an integrative literature review in which 12 articles were included. Results: Several factors were identified as important to the risk of patients exhibiting violent behavior when visiting the emergency department. Four factors amongst them were identified as especially important: waiting times under “structural factors”, patients under the influence of alcohol or narcotics under “factors related to substances”, as well as patients with psychiatric disorders under “medicinal factors”. The participants in the different studies often identified the same factors, even though they had differing opinions on the importance of the factors. The emergency department staff handled the contact with patients exhibiting violent behavior differently based on several factors such as experience. Better communication, information and an empathic treatment of could lessen the risk of violent behavior and help stave off violent behavior. Conclusion: The most common risk factors for violence in the emergency department are waiting times, alcohol and / or drug affected patients and patients with psychiatric illness. Good communication, information and empathy can reduce the risk of violence or averting violence.