Bakgrund: Cancer är en vanligt förekommande sjukdom där antalet diagnostiserade ökar. Sjuksköterskan kan i sitt yrke möta dessa patienter, därför är det en fördel att få en djupare insikt om dessa patienters upplevelser. I livets slutskede är upplevelsen av livskvalitet av betydelse. Begrepp som är betydelsefulla för livskvaliteten är hälsa, lidande och hopp. Syfte: Studiens syfte var att belysa faktorer som påverkar livskvaliteten i livets slutskede hos patienter med cancer. Metod: En litteraturbaserad studie som utgår från tolv kvalitativa vetenskapliga artiklar. Resultat: Ur analysen framkom tre kategorier; viljan att fortsätta leva som vanligt, känslomässigt förhållande till andra och kunna hantera tankar och känslor om liv och död med nio underkategorier. Diskussion: För patienter medför det utmaningar i livet att insjukna i cancer. Utmaningar består av att hålla fast vid sina rutiner i det dagliga livet, sina relationer, finna mening och vara hoppfull. Konklusion: Studien belyser betydelsen av att vårdpersonal uppmuntrar och stödjer patienten i att hålla fast vid sociala kontakter eftersom sociala relationer är betydande för patientens livskvalitet. Studien påvisar att patienter kan känna sig obekväma när de tvingas tala om döden vid fel tillfälle, därför bör vårdpersonal vara lyhörda kring patientens mottaglighet att samtala om döden. / Background: Cancer is a common disease in which the number of diagnosed increases. In the nursing profession it’s possible to encounter this group of patient’s and therefore it’s an advantage to get a deeper insight of these patients' experiences. In the end of this patient’s life the experience of the quality of life is significant. Concepts that are important of the quality of life are health, suffering and hope. Aim: The aim of this study was to illuminate the factors that affect the quality of life of terminally ill patients with cancer. Method: A qualitative literature based study based on twelve qualitative research articles. Results: Three categories emerged from the analysis; the desire of continuing living as usual, emotional relationships to others and be able to manage thoughts and feelings about life and death with nine subcategories. Discussion: For patients, it brings challenges to life by developing cancer. Challenges of sticking to their routines of daily life, their relationships, find meaning and to be hopeful. Conclusion: The study highlights importance of encourage and support from the health professionals to help patient keep their social contacts, because it’s significant for the patient’s quality of life. The study demonstrates that patients may feel uncomfortable when forced to talk about death at the wrong time, therefore health professionals should be more keen about the patient’s susceptibility to talk about death.

Bakgrund  Övervikt och obesitas är vanligt i hela världen och blir allt vanligare, vilket medför konsekvenser för individen, samhället och vården. Hög vikt är associerat med viktbias och viktstigma, som förekommer i samhällets samtliga arenor. Sjuksköterskan kan möta dessa patienter i alla delar av vården och bör därför besitta kunskap om patientgruppens upplevelser. Det teoretiska ramverket i detta arbete utgörs av Jean Watsons omvårdnadsteori Unitary Caring Science och begreppet Caritas-Veritas.  Syfte  Syftet var att undersöka hur patienter med övervikt och obesitas upplever mötet med hälso- och sjukvården.  Metod  Det här arbetet är en icke-systematisk litteraturöversikt som baseras på 15 vetenskapliga originalartiklar. Strukturerade sökningar utfördes i databaserna PubMed och CINAHL. Alla inkluderade studier har genomgått en kvalitetsgranskning och innehållet har sammanställts i en integrerad analys.  Resultat  Upplevelser av viktstigma framkom i majoriteten av studierna. Olika populationer tycks drabbas i varierande grad, vilket påverkas av ett antal faktorer. Många patienter upplevde viktstigma i vården i form av ett stort fokus på vikt och viktnedgång. Patienterna beskrev även flera sätt som viktstigma i vården påverkade deras psykiska och fysiska hälsa, deras välmående och förhållande till och nyttjande av vården. Systematiska brister i vården identifieras. Flera studier lyfte positiva aspekter av mötet med vården och önskemål från patienterna om hur de skulle vilja bli behandlade.  Slutsats  Viktstigma är genomgående i patienters upplevelser av mötet med vården och får många och omfattande konsekvenser. Resultatet belyser systematiska brister i vården och hur dessa drabbar patienter med övervikt och obesitas. Det framkommer även positiva upplevelser och önskemål från patienternas sida. Reflektion och internkritik inom hälso- och sjukvården är en förutsättning för att de önskemål och förslag som framkommit ska kunna implementeras. / Background  Overweight and obesity are prevalent worldwide and are becoming more common, leading to consequences for the individual, the society, and healthcare. Weight bias and weight stigma are associated with large weight and is present in all of society. Nurses encounter patients with overweight and obesity in all healthcare contexts and should therefore be knowledgeable about the experiences of these patients. The theoretical framework for this paper is Jean Watson’s Unitary Caring Science and the term Caritas-Veritas.  Aim  The aim was to examine how patients who are overweight or obese experience the encounter with healthcare.  Method  This non-systematic literary review is based upon 15 scientific original articles. Structured searches were performed in the databases PubMed and CINAHL. All included articles have undergone a quality assessment and the results have been compiled in an integrated analysis.  Results  Experiences of weight stigma appeared in most of the studies. Various populations seem to experience weight stigma differently and several factors appear to contribute to this. Across several studies, patients experienced that weight stigma manifested as a large focus on weight management and weight loss within healthcare. Patients also described different ways that weight stigma affected their psychological and physical health, their well-being, their relationship with healthcare and their proneness to seek care. Systematic shortages within the healthcare system are identified. Several studies highlight positive aspects of the encounter with healthcare and how the patients wish to be treated.  Conclusions  Weight stigma is present in all areas of healthcare and has extensive consequences for the patient. Systematic shortcomings in the healthcare system and how they affect overweight and obese people are identified. There are mentions of positive patient experiences as well as wishes. Reflection and internal criticism are necessary for implementation of these wishes and suggestions.

This study aimed at exploring chronic illness from both the perspectives of the patient, living with the illness and the professional, treating the illness. The epistemological framework is social constructionism. Qualitative research was selected as the research approach. Three in-depth interviews with three patients, suffering with a chronic illness were conducted, as well as three interviews with professionals, who had experience with patients diagnosed with chronic illnesses. Thematic analysis was the method used for the analysis of data. The stories of the participants were reconstructed in terms of themes. A comparative analysis for both participants groups was done, and linked to the relevant literature This study created an understanding of the complexity of chronic illness. The themes identified, highlighted the importance of the patient-professional relationship, specifically in the context of chronic illness. / Psychology / M.A. (Clinical Psychology)

Les orientations ministérielles du Québec encouragent une pratique interprofessionnelle centrée sur le patient (ICP), au cours de la trajectoire de soins, pour soutenir les patients diagnostiqués d’un cancer. Cette pratique assure une meilleure communication entre les professionnels et la sécurité des patients, et améliore les soins et l'accès aux services (Santé Canada, 2010). Cependant, les études rapportent généralement les perceptions des professionnels en regard des soins et des services et informent sur les facteurs organisationnels, procéduraux et relationnels liés à cette pratique. Considérant l’importance de celle-ci, il semble nécessaire de la documenter selon les perceptions de patients, de proches et de professionnels dans un contexte réel de soins. L’étude avait pour but de décrire la pratique ICP au cours de la trajectoire de soins en oncologie. Pour soutenir cette description, l’adaptation du cadre de référence Person centred nursing framework (PCNF) de McCormack et McCance (2010) a été réalisée en incluant l’interprofessionnalité, telle que définie par Couturier (2009) et utilisée. Une étude qualitative de cas multiples a été réalisée auprès de deux équipes interprofessionnelles d’un centre hospitalier universitaire de la région de Montréal. L’échantillon (N=31) était composé de 8 patients, 3 proches, 18 professionnels et 2 gestionnaires. Vingt-huit entrevues ont été réalisées ainsi que 57,6 heures d’observation d’activités cliniques auxquelles participait le patient (ex., rendez-vous, traitement). Les résultats suggèrent que la pratique ICP des équipes est empreinte d’un dualisme de cultures (culture centrée sur le traitement versus culture davantage centrée sur le patient). De plus, les équipes étudiées ont présenté une pratique ICP fluctuante en raison de l’influence de nombreux facteurs tels le « fonctionnement de l’équipe », l’« environnement physique » et le « positionnement » des patients et des professionnels. Les résultats ont aussi suggéré que le déploiement des équipes de soins se fait à intensité variable au cours de la trajectoire. Il a été soulevé que les patients ont pu faire l’expérience d’une pratique ICP changeante, de bris dans la continuité des soins et de transition difficile entre les différentes périodes de la trajectoire. De plus, la description d’une pratique ICP souhaitée par les patients, leurs proches et les professionnels propose un accompagnement respectant le rythme du patient, sans prédominance des valeurs du professionnel ainsi qu’une assiduité dans la collaboration des membres de l’équipe. Cette étude suggère que les sciences infirmières peuvent ajouter aux connaissances interprofessionnelles actuelles en utilisant une perspective centrée sur le patient, perspective cohérente avec ses valeurs disciplinaires. De plus, de nombreuses pistes de réflexion sont proposées pour la pratique, la recherche, la gestion et la formation. / The ministerial orientations drawn up by the Quebec government promote the concept of interprofessional patient-centred practice (IPPC) throughout the care trajectory to support patients who have been diagnosed with cancer. That form of practice improves communication between professionals and patients’ sense of security, as well as improving care and access to services (Health Canada, 2010). However, studies generally report professionals’ perceptions of care and services and provide information on organizational, procedural and relationship factors connected to that practice. It is necessary to document this important practice based on the perceptions of patients, family members and professionals in a real context of care. This study was designed to describe IPPC practice throughout the trajectory of oncology care. The Person Centred Nursing Framework (PCNF) of McCormack and McCance (2010) was adapted by integrating interprofessionality, as defined by Couturier (2009), and used to support that description. A qualitative study of multiple cases was conducted with two interprofessional teams at a teaching hospital in the Montreal region. The sampling (N=31) consisted of 8 patients, 3 family members, 18 professionals and 2 managers. Twenty-eight interviews were conducted, as well as 57.6 hours of observation of clinical activities in which patients were participating (e.g. appointments, treatments). The results suggest that the teams’ IPPC practice reflected a duality of cultures (treatment-centred culture versus patient-centred culture). In addition, the IPPC practice of teams in the study fluctuated due to the influence of many factors, such as “how the team works,” “the physical environment” and the “stance” of patients and professionals. The results further suggested that the deployment of healthcare teams varied in intensity over the trajectory. The point was raised that patients experienced a variable IPPC practice, breakdowns in continuity of care, and difficult transitions between different periods in the trajectory. In addition, the description of the IPPC practice that patients, their family members and professionals would like to see suggests a form of accompaniment that would follow the patient’s own pace, without imposing professionals’ values, with assiduous collaboration from members of the team. This study suggests that nursing could advance current interprofessional knowledge by taking a patient-centred perspective, a perspective consistent with values in this discipline. In addition, many avenues for further reflection are put forward in terms of practice, research, management and training.

This study aimed at exploring chronic illness from both the perspectives of the patient, living with the illness and the professional, treating the illness. The epistemological framework is social constructionism. Qualitative research was selected as the research approach. Three in-depth interviews with three patients, suffering with a chronic illness were conducted, as well as three interviews with professionals, who had experience with patients diagnosed with chronic illnesses. Thematic analysis was the method used for the analysis of data. The stories of the participants were reconstructed in terms of themes. A comparative analysis for both participants groups was done, and linked to the relevant literature This study created an understanding of the complexity of chronic illness. The themes identified, highlighted the importance of the patient-professional relationship, specifically in the context of chronic illness. / Psychology / M.A. (Clinical Psychology)