Background: Registered nurses in the emergency department are exposed to a high workload, and the work environment is stressful. Frequent reports of burnout in the health care profession are a fact, and nurses are a particularly vulnerable group. Aim: The aim of this study was to investigate registered nurses’ experiences of work-related stress in the emergency department. Method: A literature review including 13 quantitative and qualitative studies was conducted. The databases CINAHL and Pubmed were used to find relevant research for this study’s intended purpose. The authors read all the studies multiple times to gain understanding and to find connections between the results. Results: The findings in this study revealed three main themes: the feeling of inadequacy, not having control and, finally, the deterioration of their health. The nurses conveyed that they were not capable of performing optimal care due to a lack of recourses paired with a high workload. The feeling of endangering the patients' safety because of the nurses' stress was recurring. The nurses described multiple coping mechanisms to handle stressful situations at emergency departments, but none that really worked. Conclusion: The nurses in the emergency department feel that work-related stress has a negative impact on their mental and physical health. Feelings such as powerlessness, guilt towards the patients and shame were common. Most nurses described that they were not satisfied with the quality of the care they provided. All nurses expressed the need for more resources to manage stress and to provide appropriate patient-safe care.

Bakgrund: Idag finns cirka 150 000 individer i Sverige med demenssjukdom och gruppen växer i takt med att befolkningen blir äldre. Personcentrerad vård har sitt ursprung inom humanistisk psykologi och begreppet beskrevs redan på 1960-talet. Personcentrerad vård är en av sjuksköterskans sex kärnkompetenser och är en god grund för att tillgodose de varierande behov som finns hos den komplexa patientgruppen. Syfte: Syftet med litteraturstudien är att belysa vad sjuksköterskans erfarenheter är av att ge personcentrerad vård till patienter med demenssjukdom. Metod: En litteraturstudie vars resultat baseras på studier med kvalitativ ansats. Vid sökning användes databaserna; CINAHL, PsycINFO och PubMed. Resultatets femton artiklar analyserades enligt Forsberg och Wengströms (2016) femstegsmetod. Resultat: Resultatet presenterades med hjälp av fyra huvudteman; organisationen, patientrelationen, kommunikation, vårdmiljö samt sju underteman; stöd på arbetsplatsen, kompetensutveckling, tids- och personalbrist, livsberättelsen - patientens historia, personliga attribut, samverkan i team och dokumentationsrutiner. Konklusion: Hälso- och sjukvården är en komplex organisation och sjuksköterskan står inför många utmaningar. Otillräckligt stöd från både ledning och kollegor samt vårdmiljöns utformning var alla faktorer som påverkade sjuksköterskans möjlighet att tillgodose personcentrerad vård. Vidareutbildning i kommunikation och demenssjukdomar upplevde sjuksköterskorna gynnsamt för deras arbete. Även vikten av att ha en god relation till patienten och att lära sig deras livshistoria framhölls som viktiga komponenter i den personcentrerade vården. / Background: Today there is approximately 150 000 individuals with dementia in Sweden and the group is expanding at the same time the population is ageing. Person centred care has its roots in humanistic psychology and the concept was described already in the 1960’s. Person centred care is one of the nurses’ six core competencies and is a good foundation for the various needs amongst the complex patientgroup. Aim: The aim for the literature review is to illustrate nurses’ experiences of giving person centred care to patients with dementia. Method: A literature review with a result based on studies with a qualitative approach. Databases used was CINAHL, PsycINFO and PubMed. The fifteen articles of the result were analyzed according to Forsberg and Wengströms (2016) model of five steps. Results: The result was presented using four main themes; the organisation, patient-relations, communication, care environment and seven subthemes; workplace support, quality of competens, lack of time and personel, lifestory - a patient’s history, personal attributes, team cooperation and documentation routines. Conclusion: The health-care system is a complex organisation and the nurse faces many challenges. Insufficient support from both management and colleagues and the formation of the care environment was all factors that affected the nurses’ ability to provide person centred care. More education in communication and different types of dementia illnesses were seen by nurses as positive contribution in their work. Even the importance of having a good relationship with the patient and learn about their lifestory was brought to daylight as important components in person centred care.

Many researchers have suggested positive patient-health provider relationships can positively impact patient outcomes. A few focused explicitly on bariatric weight loss surgery (BWLS) professional-patient interactions. This study is significant because BWLS is a recommended tool to combat obesity. The purpose of this study was to analyze the perceptions of BWLS education nurses regarding their patient encounters. This mixed methods research study used an online survey combining quantitative Likert scale questions and open-ended qualitative questions, with social cognitive theory as the theoretical foundation. These explored viewpoints relate to their patient relations expressed by a health professional. Health professional beliefs incorporated into patient interactions has merit within BWLS continuum from presurgery requirements, to the procedure, and post-surgery lifestyle. Many respondents are employed in obesity services programs and received 'snowballs' from other contacted health professionals. The analyzed written response word clouds favor patient-focused care. Participation reluctance by not answering or skipping short answer perspective questions was a quantitative trend. Data revealed survey specific noticeable qualitative tendencies favorable toward patient-centered care and patient health accountability. The anticipated positive social change is a better understanding of issues surrounding the choice for and against BWLS and improved healthcare and health professional-patient communications.

Schools of nursing educators are faced with redesigning nursing education to meet the complexity of implementing communication and patient- centered care to improve patient safety. This qualitative case study addressed the problem that teaching communication and patient- centered care were not threaded throughout curriculum, which left many new graduates nurses unprepared. The purpose of this study was to understand classroom experiences of new graduate nurses to meet performance outcomes. The research questions focused on understanding the classroom experiences of new graduates' of a nursing program by assessing the two concepts and how to address preparatory practices. The target populations were new graduates' of nursing programs who had been working in a hospital for less than 1 year and are registered nurses. Emergent themes regarding the new graduates classroom experiences strengths and areas of improvements were extracted from the 10 participants interview questions, and practice experiences from the journal recordings were manually coded, validated , triangulated, and member checked with eight themes that emerged from face-to-face interviews, theoretical frameworks, and the current literature. The researcher determined that the new graduates' nurses were self-motivated to implement communication and patient centered care, however incorporating the two concepts in the class instructions would be a safer preparatory experience. This study may contribute to positive social change through raising awareness regarding the overall standard of nursing education, which may lead to a reevaluation of nursing curricula and teaching strategies so that new graduate nurses may master the complexity of clinical practices resulting in positive performance outcomes

Indiana University-Purdue University Indianapolis (IUPUI) / Symptom research with advanced lung cancer patients has primarily focused on symptom severity, frequency, and distress; yet, little is known about advanced lung cancer patients’ priorities and success criteria for symptom improvement. To address these gaps in the literature, this study examined these outcomes using a modified Patient Centered Outcomes Questionnaire (PCOQ), which has largely been used with adults with chronic pain. Advanced lung cancer patients (N = 102) were recruited from the Indiana University Simon Cancer Center to participate in a one-time self-report survey, including demographic and medical questionnaires, symptom treatment history, standardized measures of symptom severity and quality of life, and the modified PCOQ focused on eight common symptoms in advanced lung cancer. Cancer information was collected from medical records. My primary aim was to evaluate the construct validity of the PCOQ. As hypothesized, symptom severity ratings on the PCOQ were positively correlated with standardized assessments of the same symptoms as well as functional status. Greater severity of most symptoms on the PCOQ was also correlated with worse quality of life, and greater severity of four symptoms was correlated with having more medical comorbidities. Positive, moderate correlations were found between the severity and importance of seeing improvement in cough, fatigue, sleep problems, and pain on the PCOQ. Patients considered low levels of symptom severity to be acceptable following symptom treatment; no differences were found across the eight symptoms. Latent profile analysis identified four patient subgroups based on the importance of seeing improvement in each of the symptoms: (1) those who rated all symptoms as low in importance (n = 12); (2) those who rated bronchial symptoms and sleep problems as low in importance and all other symptoms as moderately important (n = 29); (3) those who rated nausea and emotional distress as low in importance and all other symptoms as moderately important (n = 23); and (4) those who rated all symptoms as highly important (n = 33). These subgroups were unrelated to demographic and clinical factors, except for functional status. Findings suggest that symptom severity and importance are related yet distinct aspects of the advanced lung cancer symptom experience. Furthermore, patients have heterogeneous priorities for symptom management, which has implications for tailoring treatment.

No description available.

Antalet personer som lever med hjärtsvikt ökar. Fatigue är ett av de vanligaste symtomen vid hjärtsvikt och kan beskrivas som en överväldigande fysisk, kognitiv och känslomässig trötthet som inte kan lindras med normala återhämtningsmetoder. Trots att fatigue har stor negativ påverkan på livskvalitet och egenvård uppmärksammas det sällan i lika stor utsträckning som övriga symtom vid hjärtsvikt. För att sjuksköterskor ska kunna erbjuda personcentrerad omvårdnad till denna komplexa och växande patientgrupp krävs ökad kunskap om hur fatigue tar sig uttryck hos personer med hjärtsvikt. Syftet med denna studie var att beskriva förekomst av fem olika dimensioner av fatigue i relation till kön, NYHA-klass och EF-kategori hos personer med hjärtsvikt. Metoden för studien var kvantitativ, med en induktiv ansats och icke-experimentell design. Datainsamlingen utfördes med hjälp av The Multidimensional Fatigue Inventory (MFI-20), en validerad enkät som identifierar fem olika dimensioner av fatigue; generell fatigue, fysisk fatigue, mental fatigue, minskad motivation och minskad aktivitet. Genom ett konsekutivt urval inkluderades 92 personer som besvarade MFI-20 i samband med ett besök på en dagvårdsmottagning för hjärtsvikt. MFI-20-enkäterna analyserades med hjälp av det statistiska mjukvaruprogrammet SPSS. Resultatet i denna studie visade att kvinnor uppgav signifikant högre nivåer av fatigue än män i tre av fem dimensioner. Oavsett kön uppgavs högst nivåer i dimensionen fysisk fatigue. Vidare indikerade resultatet att personer med högre NYHA-klass uppgav högre nivåer av fatigue och personer med HFpEF uppgav högre nivåer av fatigue än de med HFrEF. Slutsatsen är att sjuksköterskor behöver arbeta utifrån vetskapen om att fatigue är vanligt förekommande hos personer med hjärtsvikt, i signifikant högre nivåer hos kvinnor än hos män. Studiedeltagarna uppgav högst nivåer av fysisk fatigue, och omvårdnad och patientinformation behöver utformas därefter. Genom personcentrerad omvårdnad kan sjuksköterskor uppmärksamma fatigue och stötta varje person i dennes egenvård i takt med sjukdomsprogressionen. Rutiner och effektiva instrument behöver utvecklas för att kunna bedöma fatigue och utvärdera tillhörande omvårdnadsåtgärder. Vidare forskning krävs kring varför personer med bevarad pumpförmåga uppgett högre nivåer av fatigue än de med nedsatt pumpförmåga. / The prevalence of persons with heart failure is increasing. Fatigue is one of the most common symptoms of heart failure and can be described as an overwhelming physical, cognitive and emotional tiredness that is not relieved by normal recovery strategies. Despite the fact that fatigue has a negative impact on quality of life and self care, it rarely receives the same attention as other heart failure symptoms. To enable nurses to offer a patient- centered care to this complex and growing group of patients, increased knowledge concerning how fatigue is affecting persons with heart failure is needed. The aim of the study was to describe five dimensions of fatigue in relation to gender, NYHA-class and EF-category among persons with heart failure. The method of the study was quantitative, with an inductive approach and non- experimental design. Data collection was performed using The Multidimensional Fatigue Inventory (MFI20), a validated questionnaire which identifies five dimensions of fatigue; general fatigue, physical fatigue, mental fatigue, reduced motivation and reduced activity. Through a consecutive sample 92 participants were included and answered MFI-20 during an visit at a heart failure outpatient clinic. The MFI-20 questionnaires were analyzed using the statistical software program SPSS. The result of this study showed that women reported significantly higher levels of fatigue than men in three out of five dimensions. Regardless of gender the highest levels were reported in physical fatigue. Furthermore the result showed that worse NYHA-categories was associated with higher levels of fatigue. Study participants with HFpEF reported higher levels of fatigue than participants with HFrEF. The conclusion is that nurses need to base their work on the knowledge that fatigue is a common symptom in persons with heart failure, with significantly higher levels in in women than in men. Study participants reported higher levels of physical fatigue, and nursing care and patient information should be designed accordingly. Through patient- centered care nurses can identify fatigue and support patient self care as the heart failure progress. Development of routines and effective instruments is needed to assess fatigue and evaluate nursing care, as well as further research concerning fatigue in persons with HFpEF.

År 2018 drabbades cirka 24 800 personer i Sverige av hjärtinfarkt, och cirka 5800 av dem avled. Sekundärprevention kan minska risken för återinsjuknande i hjärtinfarkt. Medicinsk sekundärprevention innebär att med hjälp av läkemedel reducera riskfaktorer såsom högt LDL-kolesterol eller hypertoni. Inom sekundärpreventionen har sjuksköterskor en viktig roll i att utbilda och handleda patienter och närstående på ett personcentrerat sätt. Syftet var att undersöka patienters upplevelser av information om läkemedel som ordinerats efter hjärtinfarkt, såväl gällande informationens innehåll som hur den förmedlats. Studiens ansats var induktiv kvalitativ med en deskriptiv design, och baserades på sju intervjuer utifrån en semistrukturerad intervjuguide. Informanterna hade drabbats av hjärtinfarkt och ordinerats sekundärpreventiva läkemedel. Informanterna hade varit på återbesök hos sjuksköterska på sekundärpreventiv öppenvårdsmottagning (kranskärlsmottagning). Intervjuerna analyserades enligt en kvalitativ innehållsanalys på manifest nivå. I resultatet framträdde meningsenheter som sorterades in i tre kategorier; Information under vårdförloppet, Individanpassad information och Struktur vid informationsgivning. Flertalet informanter upplevde bristande läkemedelsinformation under tiden i slutenvården, vilket ledde till osäkerhet kring behandlingen tills återbesök skett. Informanter som erhållit information upplevde en känsla av trygghet och att känna sig införstådda med behandlingen. Majoriteten önskade läkemedelsinformation, som skulle vara tydlig, individanpassad, och påbörjas i slutenvården. Önskemål uttrycktes om att informationen skulle inkludera skälen till vald behandling, effekter och bieffekter, samt förmedlas såväl skriftligt som muntligt och repeteras vid återbesök. Studien visar att personer som drabbats av hjärtinfarkt önskar, men ofta upplever att de saknar, information och dialog kring sekundärpreventiv läkemedelsbehandling. Informationen bör förmedlas och utföras på ett personcentrerat sätt samt vara samstämmig och tydlig, och vid behov fördjupas vid återbesök. / In 2018, circa 24 800 individuals in Sweden suffered a myocardial infarction, circa 5800 fatally so. Secondary prevention can reduce the risk of recurring myocardial infarction. Medical secondary prevention entails reducing risk factors like high LDL-cholesterol or hypertension by means of medication. In secondary prevention, nurses play an important part in educating and counselling patients and relations in a patient-centered manner. The aim was to examine patients' experiences of information about medication prescribed after myocardial infarction, both regarding information content and how it had been conveyed. The study approach was inductive qualitative with a descriptive design and based on seven interviews following a semi-structured interview guide. All informants had suffered myocardial infarction and had been prescribed secondary preventive medication. All informants had met with nurses at hospital-based outpatient clinics (Coronary Artery Clinic). The interviews were analyzed according to a qualitative content analysis on a manifest level. In the results, meaning units appeared and were sorted into three categories; Information during course of medical care, Personalized information and Structure during information. Most informants experienced deficiencies in medication information during inpatient care, generating uncertainty surrounding treatment until revisits had occurred. Informants who had received information experienced a sense of security and understanding of the drug treatment. Most informants wanted information about their drugs, and that the information should be clear, personalized, and start during inpatient care. Requests were expressed that information should include reasons for selected treatment, effects and side effects, be conveyed both in writing and orally, and repeated during revisits. The study shows that people who have suffered myocardial infarction want, but often lack, information and dialogue concerning secondary prevention medication. The information should be conveyed and carried out in a patient-centered manner and be consistent and clear. The information should be repeated and, if needed, deepened during revisits.

Bakgrund: Operationssjuksköterskan ska bedriva säker vård där patienten också ska kunna känna sig säker. Personcentrerad vård är en förutsättning för säker vård och påverkas av faktorer som teamsamarbete, kommunikation och operationssalens miljö. Genom att beskriva patientens upplevelse av säkerhet vid perioperativ omvårdnad kan patientens fysiska, psykiska, sociala och existentiella upplevelser identifieras och förstås vilket är en förutsättning för personcentrerad, och därmed, säker vård. Syfte: Syftet var att beskriva patientens upplevelse av säkerhet vid perioperativ omvårdnad. Metod: En kvalitativ systematisk litteraturstudie med induktiv ansats genomfördes. Datainsamling utfördes i databaserna CINAHL och PubMed där 13 kvalitativa artiklar inkluderades efter att ha genomgått kvalitetsgranskning. För bearbetning av data utfördes en kvalitativ innehållsanalys. Resultat: De två huvudkategorierna som identifierades var att vara en del av teamet och en främmande miljö. Att vara en del av teamet beskrev patientens behov för att kunna uppleva säkerhet där även förtroende påverkade upplevelsen. En främmande miljö beskrevs med syn- och hörselintryck samt känselintryck vilka representerade det patienten upplevde fysiskt och psykiskt på operationssalen. Slutsats: Perioperativ omvårdnad kan upplevas som säker likväl som osäker vård. Med personcentrerad omvårdnad kan upplevelsen av säkerhet främjas. Operationssalens miljö har betydelse där syn-, hörsel- och känselintryck påverkar upplevelsen av säkerhet. Med tydlig information, kunskap och vägledning upplevs säkerhet i den ovissa och osäkra situationen. Kontinuerlig verbal- och icke-verbal kommunikation där den perioperativa personalen visar på kompetens och pålitlighet skapar förtroende hos patienten som då upplever säkerhet. / Bakgrund: Operationssjuksköterskan ska ge säker vård och patienten ska också kunna känna sig trygg. Patientcentrerad vård är en förutsättning för säker vård. Genom att beskriva patientens egen upplevelse av säkerheten under den perioperativa vården kan patientens fysiska, psykiska, sociala och existentiella upplevelser identifieras. Att förstå patientens upplevelse är grunden för att ge patientcentrerad vård och även säker vård. Sikta: Syftet var att beskriva patientens upplevelse av trygghet under perioperativ omvårdnad. Metod: En kvalitativ systematisk litteraturstudie med induktiv ansats genomfördes. Data samlades in via databaserna CINAHL och PubMed. 13 kvalitativa artiklar inkluderades efter en kvalitetsgranskning och en kvalitativ innehållsanalys gjordes. Resultat: De två huvudkategorierna som identifierades var att vara en del av teamet och en utländsk miljö. Att vara en del av teamet beskrev patientens behov där känslor av tillit påverkade upplevelsen av säkerhet. En främmande miljö beskrevs genom auditiva och visuella intryck och fysiska och psykiska sinnen i operationssalen. Slutsats: Perioperativ omvårdnad kan upplevas som såväl säker som osäker vård. Ett patientcentrerat tillvägagångssätt kan främja upplevelsen av säkerhet. Operationssalens miljö påverkar upplevelsen genom auditivt och visuellt intryck och fysiska och psykiska sinnen. Tydlig information och vägledning bidrar till upplevelsen av säkerhet. Kontinuerlig kommunikation som visar kompetens och tillförlitlighet skapar förtroende och en känsla av trygghet.

Nurses believe that more liberal visitation policies will cause greater work overload and decrease the quality of patient care. The purpose of this study was to investigate the effect of a liberal visitation policy on work satisfaction, beliefs, and retention of nurses. In this study, nurses were asked to complete a survey before and after implementation of a more liberal visitation policy. The nurses were surveyed using Stamps (1997) Index of Work Satisfaction and the Boswell Beliefs Inventory. Statistical analyses were conducted to discover nurses level of satisfaction and beliefs related to the new policy. Results indicate that nurses were more dissatisfied with the components of pay, task requirements, and organizational policy six months after the new policy was implemented. Beliefs about the new policy did not change over the six month period. Increased dissatisfaction with work indicates that the policy did have an effect on work satisfaction of nurses.