Background: Approximately 2,8 million surgical procedures were performed in Sweden 2016. After surgery, patients experienced different degrees of postoperative pain. Under treated postoperative pain created great suffering for patients, delayed the recovery after surgery and could increase the risk of complications. Therefore, it is of importance to explore and describe patients’ experiences regarding pain in conjunction with surgery, in order to improve postoperative pain relief from a nursing perspective. Aim: To describe how patients experience postoperative pain and pain relief. Method: A literature review was conducted in which four qualitative studies and three quantitative studies were included. The studies were subjected to assurance of quality and Friberg’s three-step analysis was used. Results: Two categories and eight subcategories emerged. The two categories were (1) The time before surgery and (2) The time after surgery. The categories illustrated how patients experienced postoperative pain and pain relief before and after surgical procedures. Conclusion: Patients had previous experiences, expectations, knowledge and beliefs about postoperative pain and pain relief that affected their experiences before surgery. After the procedure, patients' difficulty in communicating, their participation, the attitudes of healthcare professionals and the degree of attendance of the nurse were important experiences related to postoperative pain and pain relief.

Hur patienter upplever vården när de drabbas av höftfraktur är ett lite knapert utforskat område. Höftfraktur är den vanligaste orsaken till att äldre läggs in på sjukhus idag, och innebär stora kostnader för samhället. I samband med den ökande äldre befolkningen kommer även antalet höftfrakturer att öka. Det är en skada som innebär stora risker för patienten och även risk för komplikationer. Höftfraktur är ett tillstånd som medför stor smärta och immobilisering för patienten, med ett stort behov av vård och rehabilitering som följd. Syftet med studien är att belysa vuxna patienters upplevelse av den hospitala vården, efter att ha drabbats av höftfraktur. Den baseras på en analys och beskrivande sammanfattning av sex vetenskapliga artiklar med kvalitativ ansats. Resultatet beskriver patienters upplevelse av att vårdas för höftfraktur hospitalt, vilket återges i tre teman och sju underteman. I temana beskrivs hur patienten upplever mötet med vårdaren, betydelsen av kommunikation mellan vårdare och patient samt vårdarens engagemang. Vidare återges patienternas smärtupplevelse samt smärthantering. Påverkan på patienternas autonomi beskrivs också i det sista temat som skildrar hur höftfrakturen orsakar förlorad autonomi samt hur patienterna återvinner sin autonomi.I diskussionen framhävs svårigheter hos patienter att kommunicera sin smärta, få den lindrad och vårdarens ansvar att bemöta patienter med lyhördhet, respekt och acceptans. Hur man som vårdare vidrör patienten är av vikt för patientens upplevelse av vården. Förlorad autonomi kan för patienten upplevas som problematiskt och som vårdare spelar man en viktig roll i att assistera återupprättandet av den. / <p>Uppsatsen har tilldelats SÄS stipendium för studerande vid Institutionen för Vårdvetenskap, Högskolan i Borås för bästa C och/eller D uppsats som på ett berömligt </p><p>sätt behandlar integrationen av vårdvetenskap med klinisk verksamhet.</p><p>Uppsatsnivå: C</p>

SAMMANFATTNING Bakgrund: Tidigare forskning visar att vårdstudenter har stor nytta av att få delta i patientarbete i sin utbildning och fortsatta yrkeskarriär. Patienter i hälso- och sjukvård har generellt en positiv attityd till studentmedverkan. Dock är forskningen om vilken uppfattning patienter inom psykiatrisk vård har till studentmedverkan mycket begränsad. Syfte: Att undersöka hur patienter inom psykiatrisk vård upplever studenters medverkan i vården Metod: Kvantitativ studie, en enkätstudie. Patienter från tre verksamhetsområden på ett universitetsjukhus i Mellansverige tillfrågades om att svara på enkätfrågor. Resultat: Resultatet blev 655 besvarade enkäter. Av respondenterna uppgav 95 % att de ansåg att det var viktigt att studenter får träffa patienter under sin utbildning. Sjuttiosex procent var bekväma med att studenter deltar i vårdbesöket och 61 % var bekväma med att träffa studenter för enskilt samtal. Kvinnliga patienter var mindre bekväma med manliga studenter i jämförelse med kvinnliga studenter, de var också mindre bekväma om studenten var mycket ung. För manliga patienter hade vare sig kön eller ålder på studenten någon betydelse för hur bekväma de var med studentmedverkan. Patienter som träffat studenter tidigare var överlag mer bekväma med studentmedverkan. Slutsats: Patienter inom psykiatrisk vård har en positiv attityd till studentmedverkan, för kvinnliga patienter har studentens kön betydelse för hur bekväma de är. Patienter vill bli tillfrågade om studentmedverkan i god tid och på ett respektfullt sätt. Om handledare utbildas i vad som är viktigt för patienter att få veta innan de beslutar sig för om en student får delta eller inte, kommer det ytterligare öka möjligheterna för studentmedverkan.   Nyckelord: Psykiatrisk vård, Studentmedverkan, Patienters attityder / ABSTRACT Background: Previous research shows that nursing students benefit greatly from participation in patient care in their education and future careers. Patients in health care generally have a positive attitude to student participation. However, research on how patients in psychiatric care perceive student participation is very limited. Aim: To investigate how patients in psychiatric care experience student involvement in their care. Method: Quantitative study, a questionnaire study. Patients from three psychiatric departments at a university hospital in central Sweden were asked to respond to survey questions. Result: The result showed 655 completed questionnaires. Of the respondents, 95 % stated that it was important that students get to meet patients during their training. Seventy-six percent were comfortable with students participating in the health care visits and 61 % were comfortable with meeting students for individual conversation. Female patients were less comfortable with male students compared to female students and they were also less comfortable if the student was very young. For male patients either the sex or the age of the student was of any significance to how comfortable they were with student participation. Patients who had met students previously were generally more comfortable with student participation. Conclusion: Patients in psychiatric care has a positive approach to student participation, for female patients the student’s gender has an impact on how comfortable they are. Patients want to be consulted on student participation in a timely and respectful manner. If supervisors are trained in what is important for patients to know before they decide whether a student may participate or not, it will further increase opportunities for student participation. Alpha Keywords: Psychiatric Care, Student Involvement, Patient Attitudes.

Being a patient in intensive care can be experienced terrifying. Studies have demonstrated the link between unpleasant memories of hospitalization in the ICU and the development of posttraumatic stress disorder, depression, anxiety, and perception of quality of life in its aftermath. Placed on a ventilator, the patient is exposed to multiple invasive procedures. The aim was to describe critical care patients' experience of being intubated or tracheostomated. Method: Literature review using conventional content analysis. Searches were made in the databases Cinahl and Pubmed. Results: The study revealed four main categories: Discomfort, Vulnerability and Communication difficulties that were tied together by category Relief. It turned out that the patients experienced a discomfort caused by the endotracheal tube. Suctioning of airways remembered many of the patients in both discomfort and relief. Being dependent on a ventilator and equipment in order to survive, causing a feeling of vulnerability. Many patients lost hope when they could not communicate, make themselves understood and to be involved in their care. The medical staff has a significant impact on their experiences of intensive care. To find out the reason they were intubated / tracheostomated reduced their fear. This information helped them to bond with reality. The nurse has responsibility to act with compassion and empathy, theory and knowledge to reduce anxiety and facilitate hospital stay for patients.

Bakgrund: Sjuksköterskeyrket är ett kvinnodominerat yrke. I Sverige är ca 90 % av sjuksköterskorna kvinnor. Att utföra intima omvårdnadsåtgärder är en viktig del av sjuksköterskans arbete. Intima omvårdnadshandlingar är situationer då patienten blir exponerad på ett, för denna, intimt sätt. Både manliga och kvinnliga sjuksköterskor framhåller att det är en stor utmaning för dem att utföra dessa omvårdnadshandlingar på ett, för patienten, korrekt sätt.   Syfte: Att beskriva patienters inställning till intima omvårdnadshandlingar utfört av sjuksköterskor av motsatt kön. Metod: Litteraturöversikt enligt Friberg (2012). Litteraturöversikten är baserad på 11 vetenskapliga artiklar varav 6 är har kvantitativ design, 4 kvalitativ och 1 mixad metod. Artiklarna är framtagna genom sökning i databaserna CINAHL Complete och Academic Search Complete. Resultat: Resultatet presenteras i tre teman. I Patienter föredrar kvinnliga sjuksköterskor vid intima omvårdnadshandlingar framgår att patienter av båda könen helst ser att en kvinnlig sjuksköterska utför de intima omvårdnadshandlingarna. I Patienters inställning till sjuksköterskor som förkläden visar resultatet att det råder delade meningar hur patienten vill använda sig av ett förkläde eller ej. I det sista temat, Patientens inställning till sjuksköterskan och vårdrelationen vid intima omvårdnadshandlingar framkommer patienternas åsikter kring vad som är en professionell sjuksköterska och hur denna kan agera för att stärka vårdrelationen. Diskussion: Diskussionen delas upp i två teman, varför föredrar patienter kvinnliga sjuksköterskor samt Hur kan sjuksköterskan använda vårdrelation för att underlätta mötet vid intima omvårdnadshandlingar.  Resultatet diskuteras utefter konsensusbegreppet vårdande samt begreppet vårdrelation. / Background: The nursing profession is a female dominated profession. About 90 % of the nurses, in Sweden, are female. To perform intimate care is a vital part of  nurses’ work. Intimate care situations where the patient gets exposed in an intimate way e.g through undressing. Both male and female nurses emphasize intimate care activities to be challenging to perform, in a correct way. Aim: To describe patient attitudes towards intimate care performed by female or male nurses. Method: Literature review according to Friberg (2012). This literature review is based on 11 scientific articles of which 6 were of a quantitative design, 4 are of qualitative design and 1 of a mixed method. The articles were found through a search in CINAHL Complete and Academic Search Complete databases. Results: The results are presented in three themes. In patients prefer female nurses to perform intimate care it becomes evident that patients of both sex prefer a female nurse to perform the intimate care. In patients attitudes towards nurses as chaperones the results show differences in attitudes amongst patients about the usage of chaperones or not. In the final theme, patients attitudes towards nurse and the care relationship in intimate care, shows patients attitudes about what constitute a professional nurse and how they can facilitate a strengthened care relationship. Discussion: The discussion is divided in two themes, why do patients prefer female nurses and how can nurses use the care relationship to ease the encounter with intimate care. The results are discussed in relation to the concepts caring and care relationship.

Bakgrund: Amyotrofisk lateralskleros är en fortskridande motorneuronsjukdom som drabbar de nervceller som styr skelettmuskulaturen. Sjukdomen leder till en successivt ökande muskelförsvagning och till sist döden, oftast inom 3-5 år från det att diagnos satts. Sjukdomen orsakar ett stort lidande för patienten och dennes närstående då den kan vara snabbt fortskridande och oförutsägbar. Syfte: Syftet var att beskriva upplevelsen av att leva med ALS. Metod: Studien genomfördes som en kvalitativ litteraturstudie med induktiv ansats och är baserad på 10 kvalitativa originalartiklar. Artiklarna analyserades med hjälp av en manifest innehållsanalys och resulterade i 4 huvudkategorier och 12 underkategorier. Resultat: Resultatet visade att upplevelsen av att leva med ALS är individuell men vissa fynd stack ut mer än andra. Dessa var de ständiga förlusterna sjukdomen medförde, upplevelsen av att vara en börda för andra, sjukdomen gav patienten en ny synvinkel på livet samt att kunna finna mening trots sjukdomen. Slutsats: Upplevelsen av ALS är mångdimensionell och individuell. Sjukdomen innebär svåra prövningar för den drabbade individen men med rätt stöd från anhöriga och sjuksköterskan kan lidandet lindras och meningen i livet bibehållas.

Bakgrund: Patienter som skrivs ut från intensivvårdsavdelningar står inför en stor psykisk påfrestning, där fragmenterade minnen, minnesluckor och mardrömmar gör det svårt att urskilja vad som verkligen hänt och inte. Dagböcker är en billig intervention och har visat på potentiellt terapeutiska fördelar, för en population som annars löper signifikant risk för psykisk ohälsa. Syfte: Syftet med detta arbete var att beskriva patienters upplevelser av en dagbok skriven under deras vårdtid på en intensivvårdsavdelning. Metod: En beskrivande litteraturöversikt med systematisk ansats. Resultat: Fem huvudkategorier identifierades: Att läsa om sig själv i en kritisk situation, Att pussla ihop sin egen berättelse, Vikten av kontinuitet, Skapa insikt för att gå vidare, &amp; Tacksamhet till vården och närstående. Det var påfrestande att läsa dagboken i början, och många uttryckte en overklighetskänsla över innehållet. Dagboken hjälpte deltagarna att koppla ihop minnesfragment med verkliga händelser, och den var ett viktigt verktyg i att rekonstruera sin egen berättelse, däremot kunde brister i kontinuiteten sätta hinder för detta och vikten av kontinuerliga anteckningar betonades. Dagboken gav insikt i hur sjuk deltagarna varit, och gjorde det lättare att förstå varför återhämtningen var långsam. Genom att läsa sjuksköterskans och närståendes anteckningar fick deltagarna en ny förståelse och tacksamhet gentemot det stöd de haft under vårdtiden, och dagboken stod som bevis för att de alltid haft någon vid sin sida, även om de inte kommer ihåg det själva.  Slutsats: Dagboken upplevdes hjälpa den psykologiska återhämtningen och gjorde tiden på intensivvårdsavdelningen mer hanterbar, vilket gjorde det möjligt att gå vidare. / Background: Discharge from the intensive care unit comes with significant psychological strain, with fragmented memories, memory gaps, and nightmares makes it hard differentiating between actual and false memories. Diaries is a cheep intervention with potential therapeutic advantages, for a population which otherwise is at great risk of mental illness. Aim: The aim of this study was to describe patients’ experience of a diary written during their stay at the intensive care unit. Method: A descriptive literature review with a systematic approach. Results: Five main categories emerged: To read about oneself in a critical situation, To piece together ones own story, The importance of continuity, Creating insight to move on, &amp; Gratitude towards care giver and relatives. It was hard reading the diary at first, and many described a feeling of unreality. The diary aided participants in connecting fragmented memories to events, and it was seen as a crucial tool in reconstructing ones story. Lack of continuity was a hindrance, and the importance of continuous notes was stressed. The diary gave insight into how ill the participants had been, which made it easier to understand why the recovery was slow. By reading notes by nurses and relatives, the participants gained understanding and gratitude towards the support they hade received, and the diary was evidence that they always hade someone bedside, even if they can’t remember it. Conclusion: The diary was perceived to aid the psychological recovery and made the intensive care experience more manageable, which made it possible to move on.

Home physiotherapy is a valid service option for the patient who was recently discharged from hospital after sustaining a stroke, as it enhances functional independence in friendly and familiar surroundings, as opposed to an outpatient clinic (Bader 2008). The aim of this study was to investigate the system responses to the planning and implementation of a home physiotherapy service as an innovation within the Maltese Public Health Service, uncovering barriers or constraints that influenced the introduction and development of state-run home physiotherapy in Malta. Method A qualitative approach was used for this research. A case study design was selected because it possessed contextual, descriptive and heuristic characteristics. Study participants planned and implemented the service using the available resources. Policy makers, physiotherapists, stroke patients and caregivers contributed to the study through their responses to, and experiences of, this service innovation. It was both an exploration and an opportunity to learn about service innovation from a Maltese perspective. A group of stakeholders were interviewed during the planning stage (Phase 1) of the home physiotherapy service. The main purpose of these interviews was to inform the design of the service. Another group of participants was interviewed in the active service stage (Phase 2) - at the beginning and at the end. The purpose here was to gather data from their direct experiences with home physiotherapy. Documents relevant to home rehabilitation were accessed and analysed hermeneutically. These included newspaper media, as it was considered a sensitive instrument to understand social context (Catalán Matamoros 2007; Davis 1990). Findings and discussion Data analysis identified categories of findings such as ¿barriers to the implementation of a new service¿, ¿attitudes to home physiotherapy¿ and ¿fragmented rehabilitation service¿. The category components were discussed and linked to the hermeneutical analysis of documents, offering a deeper understanding of the categories within the local context, and revealing a reinforcement of establishment-based health care. Conclusion The findings of this study provided an insight into the constraints that would appear if home physiotherapy, indeed home rehabilitation, were introduced by the Maltese Public Health Service. This research had an impact on the state physiotherapy services. Recommendations to help mitigate the constraints in an overarching manner were offered at the end of the thesis. To the international reader with experience in organised home physiotherapy, this study gives a glimpse into how issues that would seem trivial and obvious at first glance become significant challenges¿.challenges that the uninitiated would need to overcome.

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Home physiotherapy is a valid service option for the patient who was recently discharged from hospital after sustaining a stroke, as it enhances functional independence in friendly and familiar surroundings, as opposed to an outpatient clinic (Bader 2008). The aim of this study was to investigate the system responses to the planning and implementation of a home physiotherapy service as an innovation within the Maltese Public Health Service, uncovering barriers or constraints that influenced the introduction and development of state-run home physiotherapy in Malta. Method A qualitative approach was used for this research. A case study design was selected because it possessed contextual, descriptive and heuristic characteristics. Study participants planned and implemented the service using the available resources. Policy makers, physiotherapists, stroke patients and caregivers contributed to the study through their responses to, and experiences of, this service innovation. It was both an exploration and an opportunity to learn about service innovation from a Maltese perspective. A group of stakeholders were interviewed during the planning stage (Phase 1) of the home physiotherapy service. The main purpose of these interviews was to inform the design of the service. Another group of participants was interviewed in the active service stage (Phase 2) - at the beginning and at the end. The purpose here was to gather data from their direct experiences with home physiotherapy. Documents relevant to home rehabilitation were accessed and analysed hermeneutically. These included newspaper media, as it was considered a sensitive instrument to understand social context (Catalán Matamoros 2007; Davis 1990). Findings and discussion Data analysis identified categories of findings such as 'barriers to the implementation of a new service', 'attitudes to home physiotherapy' and 'fragmented rehabilitation service'. The category components were discussed and linked to the hermeneutical analysis of documents, offering a deeper understanding of the categories within the local context, and revealing a reinforcement of establishment-based health care. Conclusion The findings of this study provided an insight into the constraints that would appear if home physiotherapy, indeed home rehabilitation, were introduced by the Maltese Public Health Service. This research had an impact on the state physiotherapy services. Recommendations to help mitigate the constraints in an overarching manner were offered at the end of the thesis. To the international reader with experience in organised home physiotherapy, this study gives a glimpse into how issues that would seem trivial and obvious at first glance become significant challenges - challenges that the uninitiated would need to overcome.