BACKGROUND:Patients receiving complementary and alternative medicine (CAM) therapies often report shifts in well-being that go beyond resolution of the original presenting symptoms. We undertook a research program to develop and evaluate a patient-centered outcome measure to assess the multidimensional impacts of CAM therapies, utilizing a novel mixed methods approach that relied upon techniques from the fields of anthropology and psychometrics. This tool would have broad applicability, both for CAM practitioners to measure shifts in patients' states following treatments, and conventional clinical trial researchers needing validated outcome measures. The US Food and Drug Administration has highlighted the importance of valid and reliable measurement of patient-reported outcomes in the evaluation of conventional medical products. Here we describe Phase I of our research program, the iterative process of content identification, item development and refinement, and response format selection. Cognitive interviews and psychometric evaluation are reported separately.METHODS:From a database of patient interviews (n = 177) from six diverse CAM studies, 150 interviews were identified for secondary analysis in which individuals spontaneously discussed unexpected changes associated with CAM. Using ATLAS.ti, we identified common themes and language to inform questionnaire item content and wording. Respondents' language was often richly textured, but item development required a stripping down of language to extract essential meaning and minimize potential comprehension barriers across populations. Through an evocative card sort interview process, we identified those items most widely applicable and covering standard psychometric domains. We developed, pilot-tested, and refined the format, yielding a questionnaire for cognitive interviews and psychometric evaluation.RESULTS:The resulting questionnaire contained 18 items, in visual analog scale format, in which each line was anchored by the positive and negative extremes relevant to the experiential domain. Because of frequent informant allusions to response set shifts from before to after CAM therapies, we chose a retrospective pretest format. Items cover physical, emotional, cognitive, social, spiritual, and whole person domains.CONCLUSIONS:This paper reports the success of a novel approach to the development of outcome instruments, in which items are extracted from patients' words instead of being distilled from pre-existing theory. The resulting instrument, focused on measuring shifts in patients' perceptions of health and well-being along pre-specified axes, is undergoing continued testing, and is available for use by cooperating investigators.

Bakgrund: Sjuksköterskor ska i möjligaste mån främja patientens delaktighet och egna vilja, även när patienten ej kan uttrycka den själv. Få områden inom sjukvården använder patientbrev för att tydliggöra patientens förväntningar och önskningar. Tidigare studier har visat att förlossningsbrev både har positiva och negativa effekter på patienters känsla av omvårdnaden. Syfte: Syftet var att beskriva kvinnors upplevelser av hur förlossningsbrevet påverkade deras omvårdnad vid förlossningen relaterat till Kings omvårdnadsbegrepp i det mellanmänskliga mötet. Metod: En kvalitativ innehållsanalys av bloggar. Studien analyserade 25 stycken bloggar där kvinnor skrivit om sin upplevelse av förlossningsbrev. Resultat: Kvinnor som skrev förlossningsbrev upplevde en ökad trygghet, en känsla av kontroll, att de kände sig prioriterade, att det var en bra förberedelse inför vårdtillfället samt att det förbättrade kommunikationen och informationsbytet mellan sjuksköterska och patient samt att det ökade deras autonomi. Kvinnornas upplevde missnöje då förlossningsbrevet inte följdes. Några kvinnor upplevde en rädsla att förlossningsbrevet skulle begränsa dem. Slutsats: Det är mestadels positiva upplevelser av förlossningsbrevet. Användandet bör dock ske med vetskap om att ett brev som inte respekteras eller efterlevs ökar risken för missnöje med omvårdnaden. Klinisk betydelse: Studien tyder på att ett patientbrev kan öka patienters delaktighet, trygghet, autonomi och förbättra den personcentrerade vården. / Background: Nurses should increase patient participation, even when patients’ ability to communicate is reduced. Parts of the healthcare system use patient plans to clarify patients’ expectations and wishes. Previous studies show that patient plans both bring positive and negative features to the feeling of care. Aim: The aim was to describe women’s experiences of how the birth plan affected their care related to King’s concepts of the interpersonal system. Method: A qualitative concept analysis where 25 blogs were analyzed. Result: Women who wrote a birth plan felt an increased sense of safety, control and being prioritized. Women experienced that the birth plan was a good way to prepare and that it enhanced the communication. Some women felt unsatisfied with their care when the birth plan was not followed and some were afraid that it would limit their care. Conclusion: The outcome are almost exclusively positive. But the usage of patient plans should be done with the knowledge that a plan which is not followed might cause dissatisfaction. Clinical importance: This study indicates that a patient plan could increase patients’ feelings of participation, safety, autonomy and enhance the patient centered care.

Healthcare decisions should be evidence-based and patient-centered. Patient-centered care is about providing quality care with the patient as the focus. The provider has to incorporate the patient’s values, preferences, and objectives into the clinical decision. Traditionally, clinical decisions were made by the provider alone. Healthcare decisions are complex, due to the multiple objectives and potential serious outcomes, making it difficult for the provider to facilitate shared decision-making with the patient. Decision support software can assist with decision-making, by letting the patient incorporate their preferences and perform the decision analysis. Annalisa is a decision support software that has been developed for this purpose. The objective of this thesis is to analyze Annalisa, from a multi-criteria decision analysis (MCDA) perspective and to discuss the tool’s ability to assist with healthcare decisions in a patient-centered care setting. Annalisa’s elements and method were reviewed, using information from the developers. The input data and results from two healthcare studies using Annalisa were used to analyze the tool from a MCDA and patient-centered care perspective and discuss the tool’s ability to provide aid in healthcare decisions. The tool’s method of simple additive weighting (SAW) was compared to the expected utility function using a decision tree. The developers of Annalisa focused on the simplicity and ease of use, rather than creating a new kind of decision support tool. The two example studies indicated problems with the tool’s ability to incorporate the patient’s preferences and values. However, considering that one of the goals with using a decision aid software in healthcare is to assist with decision analysis after the patient has been presented with the information in the traditional healthcare decision guide, Annalisa makes an interesting attempt to provide aid in that next step of the decision-making process.

Bakgrund: Begreppet personcentrerad vård ska kännetecknas av att vårdtagare och anhöriga blir sedda och förstådda som unika personer, med individuella behov, resurser, värderingar och förväntningar. Syfte: Att beskriva sjuksköterskors upplevelser av vad som kan påverka tillämpningen av personcentrerad vård på äldreboenden. Metod: En kvalitativ studie med semistrukturerade intervjuer med nio sjuksköterskor som arbetar inom äldreboenden i Sverige utfördes. En kvalitativ innehållsanalys användes. Resultat: Vid analysen identifierades tjugotre underkategorier, vilka delades in i huvudkategorierna; Förhållningssätt till den äldre personen, Delaktighet i vården, Kompetens i omvårdnadsarbetet, Samarbete i team, Möjlighet för dialog, Boendemiljöns inverkan, Strukturering av omvårdnadsarbetet, Arbetsmiljöns inverkan och Ledningens inflytande. Slutsats: Möjligheterna för att tillämpa ett personcentrerat arbetssätt på äldreboende är beroende av flera faktorer. Handledning är en viktig del i tillämpningen, där sjuksköterskor har en viktig roll i att föregå med gott exempel, för att uppmuntra övriga kollegor till ett personcentrerat arbetssätt. För att sjuksköterskor ska ha möjligheter att påverka övrig vårdpersonal är ledningens stöd av stor vikt, där tillfälle till utbildning och vidareutveckling hos vårdpersonalen behöver uppmärksammas mer. Organisationen behöver även arbeta för en miljö som främjar en personcentrerad vård, vilket inkluderar en god grundbemanning, kontinuitet på personal inom alla yrkesgrupper samt tid för att bemöta varje äldre persons behov. / Background: The concept of person-centered care characterizes by care recipients and relatives are seen and understood as unique persons, with individual needs, resources, values and expectations.  Aim: To describe the nurses' experiences of what can affect the integration of person-centered care in housing fpr the elderly. Method: A qualitative study with semi-structured interviews with nine nurses working in nursing homes in Sweden was analyzed by qualitative content analysis. Result: The analysis identified twenty-three subcategories, which were divided into the main categories; The approach to the older person, Participation in healthcare, Competence in nursing, Cooperation in teamwork, Opportunity for dialogue, Impact of housing environment, Structuring of nursing, Impact of work environment and Influence of the management. Conclusion: Supervision is an important part of the implementation of person-centered care in housing for the elderly. Nurses have an important role in setting a good example to encourage other colleagues to adopt a person-centered approach. In order for nurses to have the opportunity to influence other health care personnel, the management's support is of great importance, where the opportunity for education and further development of the healthcare staff needs more attention. The organization also need to work for an environment that promotes a person-centered care, which includes a good basic staffing, continuity of staff within all occupational groups and time to respond to the needs of each older person.

This PhD dissertation experimentally characterized the vibration amplitude, frequency, and energy associated with ambulance travel and defined the relationship of the vibration to safety, comfort and care of ambulance patients. Average vertical vibration amplitudes of .46 to 2.55 m/sec2 were recorded in the patient compartment of four ambulances over four road surfaces at three speed settings. Power spectrum analysis of the data revealed that the vibration energy and resulting vertical acceleration forces were concentrated in the .1 to 6 Hz range. Relationships between the measured ambulance vibration and the impact of whole body vibration on human physiology and performance were quantified. It was found that the accelerations measured in the ambulances were in excess of what is considered to be a normal human comfort level. Furthermore, the vibration measured was in a spectrum which could present physical impediments to optimum task performance for the on-board medical team. Phase portrait analysis combined with the power spectrum data revealed the presence of nonlinearities, stochastic fluctuations and time delays inherent in the data. The ambulance vibration data was then used to create a unique analytical model and library of forcing functions corresponding to the vehicles, road surfaces and vehicle speeds that were tested. Using the example of a vibration absorbing force plate fit over an existing ambulance floor, it was demonstrated how the model and forcing functions could be used to develop a control law equation to select parameters for active control of vibration to produce sustainable regions of patient safety, comfort and care.

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Trauma-provoked tinnitus challenges patients and clinicians. Effects of trauma may exacerbate tinnitus, and patients with both tinnitus and posttraumatic stress disorder rate distress levels as higher than patients who experience only one or the other. This presentation will highlight links between tinnitus and trauma histories relevant to clinical audiologists.

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The Affordable Care Act of 2010 proposed a new integrated care model for individuals with chronic mental illness and multiple medical comorbidities by using Behavioral Health Homes (BHH). The purpose of this doctoral project was to evaluate the effectiveness of the BHH in reducing emergency department (ED) use in the community mental health outpatient setting. Guided by the American Association for Critical Care Nurses synergy model for patient care a cross-sectional, post-test only with comparison group quasi-experimental research design was used. A de-identified data set of 68 patient records in the BHH group and 73 patient records in non-BHH as a control group were analyzed using logistic regression. The analysis revealed that participants in the BHH were statistically less likely to visit the ED. Sensitivity was 16.2%, specificity was 95.2%, positive predictive value was 54.5%, and negative predictive value was 76.2%. The Homer-Lemeshow and omnibus test of model coefficients showed the model was a good fit (p=.726, p=.007). Participants in BHH were .225 less likely to visit the ED. For every year of reduction in age, the odds of visiting the ED increased by a factor of 1.0. Females had a 1.8 higher odds of visiting the ED than males. This study provides evidence for the effectiveness of the BHH in reducing visits to the ED. Standard measures to track ED use in BHH are essential to understanding reasons for ED use and reducing nonurgent use. The BHH has the potential to transform health care delivery toward an all-inclusive model of care. Providers can utilize the findings of this project to promote social change by targeting patients with serious mental illness and reducing health disparities by emphasizing preventive care and eliminating barriers to care.