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Background: Cancer is one of the most common diseases in Sweden. When illness can no longer be cured, the patient is transferred to palliative care. The majority of palliative care is performed in hospitals. The goal of palliative care is to alleviate suffering and promote quality of life. Research has shown clear insufficiency in palliative care. From a patient perspective, insufficiency is mostly common in pain relief, communication and care environments. Aim: The aim of the literature review was to describe patients' experiences of palliative care in hospitals in the event of cancer. Method: This general literature review was based on twelve original articles with a qualitative approach that were analyzed using thematic analysis. Results: Three themes were identified: The importance of being seen as a whole person, The importance of pain relief and The importance of a good care environment. The patients were generally satisfied with the palliative care in the hospital. The importance of good pain relief and a good care environment at the hospital as well as a functioning communication with the care staff was emphasized. Conclusions: The patients who were cared for in the palliative care ward had different nursing experiences. Through patient experiences of palliative care, the nurse can increase the understanding of the patient's care needs. The knowledge can be used to give the patient an improved quality of life and alleviate suffering. / Bakgrund: Cancer är en av de vanligaste sjukdomarna i Sverige. När sjukdom inte längre går att bota övergår vården till att bli palliativ. En stor del av palliativ vård utförs på sjukhus. Målet med den palliativa vården är att lindra lidande och främja livskvaliteten. Forskning har påvisat tydliga brister inom den palliativa vården. Ur patientperspektiv är det framför allt brister inom smärtlindring, kommunikation och vårdmiljöns utformning. Syfte: Syftet med litteraturöversikten var att beskriva patienters upplevelser av palliativ vård på sjukhus vid cancersjukdom. Metod: En allmän litteraturöversikt baserad på tolv originalartiklar med kvalitativ ansats som analyserades med hjälp av tematisk analys. Resultat: Tre teman identifierades: Betydelsen av att bli sedd som en hel människa, Vikten av smärtlindring och Vikten av en god vårdmiljö. Patienterna var överlag nöjda med den palliativa vården på sjukhus. Vikten av en god smärtlindring och en bra vårdmiljö på sjukhuset samt en fungerande kommunikation med vårdpersonalen betonades. Slutsats: Patienterna som vårdades på palliativ vårdavdelning hade olika vårdupplevelser. Genom patientupplevelser av den palliativa vården kan sjuksköterskan öka förståelsen för patientens vårdbehov. Kunskapen kan användas för att ge patienten förbättrad livskvalité́ och lindra lidande.

Bakgrund: Stroke är en folksjukdom som drabbar ungefär 30 000 personer i Sverige varje år och beräknas kosta samhället runt 18 miljarder kronor. Rehabiliteringen efter stroke är ofta intensiv, mångfacetterad och långvarig. Syfte: Syftet var att beskriva patienters upplevelser i samband med rehabiliteringen efter stroke samt att beskriva undersökningsgruppen i de ingående artiklarna. Metod: En beskrivande litteraturstudie som grundar sig på 12 kvalitativa artiklars resultat. Resultat: Stroke upplevdes som en omvälvande livshändelse och huvudmålet med all rehabilitering var att få återgå till det liv som patienterna levt innan stroken. Hoppet om att återfå förlorade funktioner upplevdes som viktigt och varje tecken på förbättring gav motivation till fortsatt rehabilitering. Det var stor kontrast mellan de patienter som upplevde delaktighet i rehabiliteringsprocessen och de som önskade att de hade haft ett större inflytande. Kvinnor upplevde sig mindre delaktiga än män. Det framkom att patienter upplevde att de hade skrivits ut för tidigt från strokeenheten och inte förberetts tillräckligt inför hemkomsten. Den nedsatta funktionsnivån blev mycket tydligare när de kom tillbaka till sin vardag hemma och de saknade den nära kontakten och erfarenhetsutbytet som de hade haft med andra patienter på sjukhuset. Slutsats: Det framkom att patienter med stroke har skilda upplevelser beträffande mål, stöd, information och delaktighet i rehabiliteringen. Ett individanpassat förhållningsätt till patienters målsättningar är betydelsefullt och adekvat information viktigt. Ändamålsenligt stöd från vårdpersonal bidrar till ökad delaktighet samt ökar patientens förmåga att utföra och klara av aktiviteter i rehabiliteringen. / Background: Stroke is a disease that affects approximately 30,000 people in Sweden each year, and is estimated to cost society around SEK 18 billion. Rehabilitation after stroke is often intense, multi-faceted and long lasting. Aim: The aim of the present study was to describe patients' experiences of rehabilitation after stroke and to describe the study group in the included articles. Methods: A descriptive literature review based on 12 qualitative studies. Results: Stroke was perceived as a disruptive life events and the main goal of all rehabilitation was to return to the life that patients lived before the stroke.The hope of regaining lost functions were perceived as important and any signs of improvement gave motivation to continue rehabilitation.The contrast was considerable between those patients who experienced participation in the rehabilitation process, and those who wished they had a bigger influence.Women felt less involved than men. It was revealed that the patients felt that they had been discharged prematurely from the stroke unit and were not prepared for the homecoming. Their reduced abilities became much clearer when they returned to their everyday lives at home and they lacked the close contact and the exchange of experiences they had had with other patients in the hospital. Conclusion: It was found that patients with stroke have different experiences regarding goals, support, information and participation in rehabilitation. An individualized approach to patient goals is significant and adequate information is important. Effective support from health professionals contribute to increased participation and increase the patient's ability to perform and manage activities in the rehabilitation.

Magister Artium - MA / Background: Physiotherapists are involved in the management of patients in the cardiothoracic Intensive Care Unit (ICU). Patient and family perception of care has become an important measure in evaluating the quality of care, including care in the intensive care setting. Overall Aim: To explore and describe the family and patient perception of physiotherapy care rendered in a public sector cardiothoracic ICU in the Western Cape, South Africa. Method: This study was conducted in two phases. Phase 1 (scoping review) identified and described available outcomes for measuring family perception of ICU care by searching six databases from inception to the 20th June 2018. Results from the scoping review informed the discussion schedule for the first primary study of Phase 2. Phase 2 (two exploratory descriptive qualitative primary studies) explored and described i) family perception and ii) patient perception of physiotherapy care in a cardiothoracic ICU. Audio-taped, individual face to face semi-structured interviews were conducted with family and patient participants that met the inclusion and exclusion sampling criteria (purposive sampling). Data was transcribed verbatim and analysed using deductive-inductive thematic content analysis. The data was coded, categorised and themes were generated. Trustworthiness of the data was ensured through methods addressing credibility, dependability, confirmability and transferability. Results: A total of ten full text studies were included in the scoping review. Included studies were published between 2006 and 2017, were conducted in both developed and developing countries, in different ICUs (except cardiothoracic ICU)and all used different quantitative outcome measures to measure family perception of ICU care. Thirteen cardiothoracic ICU patients and their respective family members partook in the studies describing patient and family perception of cardiothoracic ICU physiotherapy care. The median patient age was 62 years; the mean ICU length of stay 6 days and the median family age was 55. Themes arising from the family perception of care data analysed included: i) understanding of physiotherapy care (the role of the physiotherapist, perceived benefit of physiotherapy and communication), family involvement in physiotherapy care (physical presence during physiotherapy sessions and decision-making), and satisfaction of physiotherapy ICU care. Themes arising from patient perception of care data analysed included: i) Physiotherapy management of patients, ii) The Physiotherapists – skill, iii) knowledge and professionalism, iv) Continuity of Care, v) Tangibility, vi) Physiotherapy benefits, vii) Decision-Making, viii) Communication, ix) Satisfaction of Physiotherapy ICU care. Overall, family and patients were satisfied with the physiotherapy care in the cardiothoracic ICU. However, there were areas of improvement such as the understanding of physiotherapy care, communication, family involvement in the physiotherapy care and decision-making. Conclusion: While there are multiple quantitative measures for measuring family perception of ICU care there is no “gold” standard measure that has been identified. A qualitative measure and research design would allow richer in-depth information on family perception of ICU care. The findings from the family and patient perception of cardiothoracic ICU physiotherapy care are influenced by many factors. While family and patients perceive cardiothoracic ICU physiotherapy care both positively and negatively, the majority of patient and family were satisfied overall with the care the patient received. Family perception of ICU physiotherapy care should be evaluated in order to identify areas for improvement in quality of care and could add to the body of evidence in ICU physiotherapy practice.

As part of healthcare reform through the Affordable Care Act of 2010, hospitals across the United States are being held accountable for providing a positive patient experience and will lose up to 2% of their reimbursement by 2017 if they fail to reach targeted scores. The purpose of this quality improvement project was to review the process used by a Georgia hospital to educate newly-hired nurses about customer service expectations and to provide recommendations for process improvement. Theoretical foundations supporting customer service included the caring philosophy of Mayeroff; the caring theories of Watson, Leininger, Boykin, and Nyberg; and Roy's adaptation theory. Using the plan-do-study-act model, the project began with a literature review to discover evidence-based customer service strategies. A qualitative evaluation was then conducted of the organizational documents (job description, annual review form, orientation checklists, clinical orientation record, the Standards of Behavior Form) and the educational slide presentations to determine how customer service was presented to new employees. The customer service strategies introduced during orientation and reinforced by the organization in employee evaluations were compared with evidence-based strategies. Improvement recommendations were developed and presented to the 13 nursing leaders of the organization. Materials developed to improve customer service included a poster for display, a tool for examining customer service strategies in hourly rounding, and a performance competency tool to assess nurses' customer service delivery. The project promotes social change by enhancing nurse-patient interactions, improving patients' perceptions of care, and increasing trust between the patients and the healthcare team to improve patient outcomes.

Many patient-level barriers to more effective post-fracture osteoporosis (OP) management are associated with patients’ perceptions of their bone health and the link between their fracture and OP. These barriers could be addressed by interventions which account for the role of patients’ perceptions, such as those based on theories of behaviour change. This thesis had two objectives: to review the literature and determine whether these theories have been integrated in post-fracture OP management and to examine patients’ awareness of the OP-fracture link. The results showed that theories of behaviour change have not been integrated into post-fracture interventions, that most patients do not perceive the OP-fracture link even after a baseline intervention and that two baseline factors predict who is less likely to make the OP-fracture link at follow up. Based on these findings, modifications to current OP interventions were proposed and guidance that could help create new, patient-centered interventions was provided.

Many patient-level barriers to more effective post-fracture osteoporosis (OP) management are associated with patients’ perceptions of their bone health and the link between their fracture and OP. These barriers could be addressed by interventions which account for the role of patients’ perceptions, such as those based on theories of behaviour change. This thesis had two objectives: to review the literature and determine whether these theories have been integrated in post-fracture OP management and to examine patients’ awareness of the OP-fracture link. The results showed that theories of behaviour change have not been integrated into post-fracture interventions, that most patients do not perceive the OP-fracture link even after a baseline intervention and that two baseline factors predict who is less likely to make the OP-fracture link at follow up. Based on these findings, modifications to current OP interventions were proposed and guidance that could help create new, patient-centered interventions was provided.

Background: The overall quality of care has been defined in terms of a set of seven core attributes taken from contemporary conceptual frameworks for assessing primary healthcare systems. Attributes are assessed using sub-attribute questions picked from previously developed and validated national level survey instruments. Data has been collected through structured questionnaire survey utilizing Likert items and scale to capture respondents’ perceptions of care. Both descriptive and nonparametric statistical methods have been used for data analysis. Information on demographic factors helped to understand the response patterns across different cohort groups. Key objectives: 1) To determine the perception of patients and physicians regarding the overall quality of care and its constituent elements delivered through the primary healthcare clinics in Winnipeg. 2) To compare the perceptions about different quality of care attributes as expressed by participating patients and physicians. Results: Both patients and physicians have positive views about the overall quality of care (median score >=4 on a 1-6 scale). Regarding individual attributes, “Interpersonal communication” and “Respectfulness” received the highest average score (5) and long-term health management received the lowest score (2). Patient and physician responses were found to be statistically different for access, comprehensiveness and long-term health management. The long wait time for seeing a doctor appeared to be a widely shared concern – only 43% of the patients urgently needing to see a doctor could get a same-day appointment; for non-urgent cases, less than 3% got a same-day appointment. Patients with higher educational levels appeared to be more critical about the quality of care; conversely, patients in good health rated the quality of care attributes more favourably. Conclusion: Patients and physicians are generally satisfied with the overall quality of care. However, patients have identified issues related to access, comprehensiveness of care and long-term health management. Patients concerns were found to be consistent with national level results. Long wait time was also flagged as a key concern. Primary healthcare clinics should proactively seek patient feedback to identify issues and improve their quality of service.

Fibromyalgi (FMS) är ett syndrom som främst karaktäriseras av kroniska smärtor i olika delar av kroppen. Patienter med FMS upplever ofta skepsis och misstro i mötet med vården på grund av att deras symptom är osynliga. Samtidigt kan det vara svårt för sjuksköterskor och övrig vårdpersonal att veta hur de ska förhålla sig till en sjukdom som inte uppvisar några kliniska fynd och vars etiologi fortfarande är relativt okänd. Dessa omständigheter gör vårdrelationen komplex. Syftet med denna studie är därför att utforska hur vårdrelationen upplevs mellan patienter med FMS och sjuksköterskor. 11 artiklar har analyserats, ur vilka ett huvudtema, fyra teman och två subteman identifierades. Resultatet visar att brist på tid, kunskap och förståelse resulterar i en problematisk vårdrelation. Betydelsen av att vårda dessa patienter i ett multiprofessionellt team framgår även. I diskussionen utvecklas på vilka sätt patienter med FMS och sjuksköterskor upplever vårdrelationen olika. Sjuksköterskornas känslor av maktlöshet kan från patientens sida istället uppfattas som ointresse och brist på engagemang, vilket kan medföra att patienterna tar med sig negativa känslor in i nya vårdmöten.

Bakgrund: Diabetes mellitus är en folksjukdom som kan leda till tidig död, främst på grund av hjärt- och kärlsjukdom. Diabetes mellitus har två typer av sjukdomar, vilket är typ ett och två. Båda är kända med förhöjda blodsockernivåer. Diabetes mellitus typ två handlar om insulinresistens och delvis insulinbrist. Sjukdomen kan yttra sig med två typer av komplikationer, nämligen mikrovaskulära och makrovaskulära. Behandlingen av Diabetes mellitus typ två är främst medicinering, kost och motion som förändrar livsstilen. Här är egenvård mycket viktigt och sjuksköterskan måste undervisa och informera på rätt sätt. Syfte: Syftet med studien är att beskriva patientens upplevelse av att leva med diabetes mellitus typ två. Metod: Metod som används är en litteraturöversikt med nio vetenskapliga artiklar. Datainsamlingen gjordes med sökord i databaserna CINAHL och Medline. Resultat: Resultatet visar att patientens upplevelser av att behöva göra förändringar i livsstilen handlar om att få stöd och känna hopp i framtiden i förhållande till diabetes mellitus typ två. Kost- och motionsförändringar påverkar patientens upplevelser och känslor. Patienten kan även ha emotionella upplevelser vid diabetes mellitus typ två, vilket kan vara känslor som skuld och skam. I det här läget ska patienten acceptera sjukdomen. Patienten kan ha upplevelser som ånger, motivationsbrist, hopplös, utmaning, ångest, skuld, skam och svårt att acceptera sjukdomen.y Diskussion: Patienten med diabetes mellitus typ två bör ändra sin kost och motion för att kunna få en bättre hälsa. Samtidigt ska sjuksköterskan inte glömma bort patientens upplevelser som kan leda till olika konsekvenser. Kost och motion har varit en utmaning för vissa patienter i livsstilen, som kan associeras med livslidande.