Bakgrund: Vid psykisk sjukdom kan behov av heldygnsvård uppstå för att den enskilde personen inte skall utgöra någon fara för sig eller för tredje part. Vården kan vara av nytta trots att personen i fråga inte ger medgivande till vård, vilket medför ett etiskt dilemma för vårdpersonalen. Syfte: Att belysa patienters upplevelse av att vårdas enligt tvångslagstiftning vid en psykiatrisk avdelning. Metod: En litteraturstudie har genomförts som omfattar 11 kvalitativa vetenskapliga artiklar. Resultat: Resultatet visar att patienterna antingen upplevde att inläggningen varit till nytta eller till skada och att flertalet patienter upplevde en bristande autonomi och en känsla av minskat människovärde. Slutsats: Slutsatsen är att patienternas syn på inläggningen beror på dennes upplevelse av bevarad autonomi och möjlighet till delaktighet. Personal som har ett förhållningssätt som främjar detta, främjar också att patienten upplever den tvångslagstiftade vården som nödvändig. Detta förtydligar vikten av att i vården arbeta personcenterat och med ett förhållningssätt som främjar patientens autonomi och delaktighet. / Background: When a person is mentally ill, they might need hospitalisation against their ill, to protect them from themselves or to third parties. The care may be beneficial even though the person does not give consent to treatment, resulting in an ethical dilemma for caregivers. Aim: To elucidate patients' experiences of being cared for under a compulsory admission at a psychiatric ward. Method: A literature review has been carried out covering 11 qualitative research articles. Results: The results show that patients either feel that the admission was beneficial or detrimental, and that most patients experience a lack of autonomy and a sense of diminished human dignity. Conclusion: It is concluded that patients' views on the admission depends on his or hers experience of preserved autonomy and the opportunity to participate. Staff who have an attitude that promotes this, also encourages the patient to experience the compulsory care as necessary. This clarifies the importance of working personcentered with an approach that promotes patient autonomy and participation.

Summary Background: Person-centred care is a concept which aims to achieve quality in health care. Person-centred care is about taking the patient's own story into account and creating a partnership between all involved parties. Aim: Exploring nursing students` perception of person-centred care in Vietnam. Method: This study is a qualitative study with a semistructured interview guide. It has a deductive approach with a directed content analysis. Twelve nursing students were interviewed in this study. Result: The result showed that communication, nurses' knowledge, mutual respect, cooperation and family’s experienced knowledge about the patient were identified as important parts of the participants perceptions about person-centred care in Vietnam. Challenges such as time constraints and misunderstandings were shown to be a repeating problem. Conclusion: The nursing students' perception about implementing person-centred care in Vietnam is positive, but there are challenges in applying this in practice. The number of patients related to the number of nurses is uneven, which may lead to problems in Vietnam regarding person-centered care.

Svensk patientlag fastställer att patienter med stort vårdbehov ska ha en fast vårdkontakt (FVK). Inom ramen av god och nära vård ska FVK erbjudas till dessa patienter. FVK förutsätter att vårdpersonalen antar ett personcentrerat arbetssätt och upprättar en hälsoplan i samskapande med patienten. I kontrast upplever sjuksköterskorna att de saknar stöd och kunskap om arbetssättet FVK. Detta leder till att patienterna känner sig otrygga, är frekvent vårdsökande och träffar olika vårdpersonal. Syftet var att förbättra trygghet och kontinuitet för patienter listat på en vårdcentral i Dalarna genom att erbjuda FVK till dessa patienter. Det specifika målet var att erbjuda tolv patienter en FVK inklusive hälsoplan inom sex månader samt att förbättra sjuksköterskornas kunskap om arbetssättet FVK. Syfte med studien var att evaluera om patienter ansåg att deras vårdbehov tillgodoses genom arbetssätt FVK och beskriva sjuksköterskorna erfarenhet av arbetssättet. Förbättringsarbetet inkluderade Nolans’ förbättringsverktyg, patientinvolvering och kunskapshöjande insatser för sjuksköterskor. För att undersöka hur arbetssättet FVK upplevs av patienter och sjuksköterskor genomfördes en mixad-metodstudie. En enkät riktat till patienter utformades och tre fokusgruppintervjuer, en dyad och en enskild intervju med sjuksköterskorna genomfördes. Inom sex månader hade tolv patienter en FVK tilldelad varav tio patienter hade en hälsoplan. Patienterna uttryckte att deras vårdbehov tillgodoses genom arbetssätt FVK vilket stämmer överens med sjuksköterskornas uppfattning att deras patienter söker mindre vård. FVK ökar trygghet och kontinuitet för patienter med stort vårdbehov under omständigheter som tillåter sjuksköterskorna att anta personcentrerat arbetssätt. Patienterna upplever att deras vård förbättrats och sjuksköterskorna att arbetssättet FVK ger mer värde. Studien var småskalig och begränsat till en mindre vårdcentral vilket limiterar dess överförbarhet till andra verksamheter och fler studier behövs. / The Swedish Health law obliges healthcare centers to assign case managers for patients in need. Good quality in local health care thus includes providing case managers. The case manager method presupposes that care staff adopts a person-centered manor and creates care in co-production with the patients. In contrast the nurse lacks support and knowledge to provide case management. This results in patients feeling insecure, seeking frequently for health related afflict and meeting various caregivers. To improve safety and continuity for patients in need one healthcare center in the county of Dalarna has decided to provide case management for patients assigned to the center. The specific goals were to assign twelve patients to a case manager, including health care plan within six months, and to increase knowledge for nurses. Aims of the study were to describe patients’ perception whether they consider if their needs are accommodated by the case manager, and nurses’ experiences to work as a case manager. Nolans’ improvement tool was used involving patients in their care as well as training nurses in case management skills. To study the effect of case management on patients and nurses a mixed-method design was conducted. A patient questionnaire was performed and three focus group interviews, one dyad and one individual interview with nurses were conducted. Twelve patients were assigned a case manager after six months. Ten patients had an established care plan. The patients expressed that their need of care was accommodated which is in coherence with the nurses who described that their patients were in less need for care. Case managers improve safety and continuity for patients in need under circumstances that allow nurses to develop person-centred manor. Patients expressed care improved and nurses increased work values. Yet this survey was limited to a small unit and further studies are needed.

Bakgrund: Det finns idag tydliga signaler om att hälso- och sjukvården ska ge en personcentrerad vård till samhällets individer.  Det finns även en önskan att öka möjligheten för patienten att vara delaktig i sin vård. En personcentrerad vård kan ge möjlighet för patienten att bli medskapare och inte enbart mottagare av vård. Syftet: Förbättringsarbetets syfte var att öka patientens möjlighet till delaktighet genom att implementera patientberättelse och hälsoplan. Studiens syfte är att synliggöra medarbetarnas erfarenheter av att arbeta med patientberättelsen och hälsoplanen samt patientdelaktighet i vården.  Metod: Förbättringsarbetet genomfördes med stöd av Nolans förbättringsmodell samt kartläggning av enheten utfördes med hjälp av 5P. De idéer som testades var införande av patientberättelse och dokumenterad hälsoplan. Datainsamling till studien gjordes med intervjuer av sex medarbetare som analyserats med kvalitativ innehållsanalys.  Resultat: Andelen patienter som angav att de var delaktiga i den utsträckning de önskar i vården på avdelningen, ökade från 77% till 95% vilket kan ses som ett positiv effekt på patientdelaktighet. I den kvalitativa innehållsanalysen identifierades tre kategorier: patientens vård, kommunikation samt organisationen och arbetssätt, där både möjligheter och hinder kunde ses.  Slutsats: Personcentrerad vård ökar möjligheten för patienten att vara delaktig i sin vård på en akutkirurgisk vårdavdelning. / Background: There are clear signals that health care should provide person-centered care for the citizens. There is also a wish to increase the possibility for the patient to be involved in their care. The person-centered care can provide an opportunity for the patient to become co-creators and not only recipients of care. Purpose: The purpose of the improvement work was to increase the patient's opportunity for participation by implementing patient narrative and care plan. The purpose of the study is to make visible the employees' experience of working with the patient narrative and care plan to create patient participation.  Method: The improvement work was implemented with the support of Nolan's improvement model and 5P was used to assess the unit. The ideas tested were the introduction of a patient narrative and a documented care plan. Data collection for the study was conducted with interviews of six employees and analyzed with qualitative content analysis.  Results: The proportion of patients who felt that they had participated in the decisions regarding their care/treatment on the ward to the extent they wanted, increased from 77% to 95%, that can be seen as a positive effect on patient participation. The qualitative content analysis of interviews with employees was identified in three categories: the patient's care, knowledge/communication and organization/working methods where both facilitators and barriers could be seen. Conclusion: Person-centered care increases the possibility for the patient to participate in their care in an emergency surgical ward.

This thesis aims to highlight the relevance of patients engaging with their patient narratives as a tool in recovery from illness and in regaining their sense of agency. / This thesis aims to rename the term ‘illness narrative’ to a more disclosive writing called the ‘patient narrative’ as a means to focus on the patient as a person who experiences illness, instead of the illness label. Exploring patient narratives, such as Susannah Cahalan’s Brain on Fire: My Month of Madness, as a form of disclosive writing will highlight the need for this tool to act as a more personal and effective communication between patients, healthcare professionals, and caregivers. The thesis is presented in two parts: a critical essay and my patient narrative. Part One is a critical essay that explores how engaging with patient narratives contributes to the patient reclaiming their agency and sense of identity. In three subsections, the essay highlights the difficulties patients go through with illnesses or rare medical events, as well as the emotional and physical impacts that they experience, going beyond medical symptoms. The essay focuses on three points separated into three sections. The sections are: Recognizing Pathologies and Injuries, Communication and Language in the Patient Experience, and Reclaiming Agency. Part Two is my autopathography centring on the complications encountered while seeking a common surgery. After general anaesthesia, I develop Postoperative Cognitive Changes of unknown aetiology. This greatly complicates the situation when surgery is needed, and the ensuing cognitive impairments have lasting impacts on me academically, personally, emotionally, and socially. While both parts are distinct, together they mirror how patient narratives have the iv potential to bridge the communication gap between medicine and humanities. As such, patient narratives can communicate connections between patients, medical communities, and a broader audience which acts to underscore the need of a deeper awareness for the importance of compassion and empathy for those experiencing any form of health challenge. / Thesis / Master of Arts (MA) / Patient narratives are a form of expressive writing that enables the patient to regain their sense of identity and agency following a health illness. When a person first becomes a patient, they leave their known world of familiarity and comfort and enter into a new one on their health journey. Their language and ways of communicating are required to adapt to the world of medicine. The patient loses their sense of identity and agency as a result of their illness. This thesis is presented in two parts, a critical essay and my brief patient memoir, and will explore how the patient, when engaging with patient narratives such as Susannah Cahalan’s Brain on Fire: My Month of Madness, can reclaim their agency and sense of identity. The first part is an essay exploring the contributions of patient narratives. The second part is my memoir, exemplifying a patient narrative.

Bakgrund: Patienters delaktighet i sin vård ses idag som en självklarhet i Sverige och personcentrerad vård (PCV) är ett verktyg för att öka delaktigheten. Genom att lyssna till patientens berättelse, sträva efter ett jämbördigt partnerskap och dokumentera det som framkommer får sjuksköterskan möjlighet att med patienten skapa en hållbar och långsiktig effekt av vården. Inom tvångsvården enligt Lagen om psykiatrisk tvångsvård (LPT) ges sjukvården rätten och skyldigheten att vårda patienten mot deras vilja när det anses vara befogat för att skydda patientens liv och hälsa. Enligt LPT är syftet med tvångsvården att förmå patienten till att ta emot vården som erbjuds frivilligt.   Syfte: Syftet med denna studie är att undersöka erfarenheter hos sjuksköterskor i psykiatrisk vård av att arbeta med PCV med patienter som vårdas enligt LPT.  Metod: Studien har genomförts med en kvalitativ semistrukturerad intervju. Detta har sedan analyserats med en kvalitativ innehållsanalys.  Resultat: Studiens resultat uppvisar erfarenheter av att främja patientberättelsen men även hinder för denna. Det framkommer även erfarenheter av partnerskap som bedrivs under LPT. Partnerskapet främjas till stor del av sjuksköterskans bemötande. Till sist framkommer erfarenheter av dokumentationens betydelse för PCV som bedrivs enligt LPT. Slutsats: Utifrån den fakta som läggs fram rörande PCV och LPT i bakgrunden är dessa två begrepp relativt komplicerade att förena. I resultatet av denna studie kan det konstateras att delaktighet kan främjas PVC i vård som bedrivs enligt LPT, som i sin tur främja delaktighet. Förhållandet mellan begreppen PCV och delaktighet blir i det närmsta cirkulärt där de stödjer varandra och skapar uppbyggande symbios Kliniska implikationer: Baserat på resultatet framkommer en tilltro till att PCV kan vara positiv i bemärkelsen att det skapas ökad delaktighet mellan patient och sjuksköterska i vård som bedrivs enligt LPT. / Background: Patients' participation in their care is today seen as a matter of course in Sweden and person-centred care (PCV) is a tool to increase participation. By listening to the patient's story, striving for an equal partnership and documenting what emerges, the nurse has the opportunity to create a sustainable and long-term effect of care with the patient. In coercive care under the Compulsory Psychiatric Care Act (LPT), healthcare is given the right and obligation to care for the patient against their will when this is considered justified to protect the patient's life and health. According to LPT, the purpose of coercive care is to induce the patient to receive the care offered voluntarily.   Aim: The aim of this study is to investigate the experiences of nurses in psychiatric care of working with PCV with patients being cared for according to LPT. Method: The study has been conducted with a qualitative semi-structured interview. This has then been analyzed with a qualitative content analysis. Results: The results of the study show experiences in promoting the patient's story but also obstacles to it. There is also experience of partnerships conducted under LPT. This partnership is largely promoted by the nurse's treatment. Finally, experience of the importance of documentation for PCVs carried out under LPT emerges. Conclusion: Based on the facts presented regarding PCV and LPT in the background, these two concepts are relatively complex to reconcile. In the results of this study, it can be concluded that participation can be promoted PVC in care conducted according to the LPT, which in turn promotes participation. The relationship between the concepts of PCV and participation becomes almost circular where they support each other and create constructive symbiosis. Clinical implications: Based on the results, there is a belief that PCV can be positive in the sense that increased participation between patient and nurse is created in care conducted according to LPT.

No description available.